Eric H Serrano Forty, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30867 Issued in TX

Practice address

Magnolia Ave.
H-1
Bayamon, PR 00956

Phone

(787) 786-5819

Fax

(787) 798-5749

NPI assigned

Dec 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cossma Inc

  • Primary Care Clinic/Center
  • Cidra, PR
  • NPI 1437235793
  Medicare reassignment NPD
• Cossma, Inc.

  • Clinical Medical Laboratory
  • Humacao, PR
  • NPI 1407408347
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586217600000",
    "number": "1417012709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3722",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009580722",
            "telephone_number": "787-786-5819",
            "fax_number": "787-798-5749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MAGNOLIA AVE.",
            "address_2": "H-1",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "00956",
            "telephone_number": "787-786-5819",
            "fax_number": "787-798-5749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRANO FORTY",
        "first_name": "ERIC",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "1945",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "30867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSS MEDICAL PLAN",
            "identifier": "4-1772SE",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Enrique Segura Nieves, M.D.
• Senen Segura Nieves, D.D.S.
• Joham Senior Marino, MD
• Carlos Alexis Sepulveda, MSW
• Jessica L Sepulveda, M.S.
• Yanissa Serrano Gonzalez, CPHT
• Chelsea Serrano Lopez
• Ana Michelle Serrano Ramos
• Kiara Liz Serrano Vazquez, MD
• Nereida Serrano-Correa, PH.D.

• General Practice Dentistry in Bayamon, PR
• Providers in Bayamon, PR by specialty
• General Practice Dentistry in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.