NPIMap

Organization Active NPI

MG Dental Care P.S.C.

  • General Practice Dentistry
  • San Juan, PR
National Provider Identifier
1417318684
Registry record updated Mar 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2658 Issued in PR
Legal business name
MG DENTAL CARE P.S.C.
Practice address
255 Calle Eleonor Roosevelt
San Juan, PR 00918-2806
Phone
(787) 763-9190
Fax
(787) 763-9587
NPI assigned
Mar 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2016

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

Authorized official

Name
Dr. Mardily Gonzalez, D.M.D.NPI 1497721310
Title
President
Phone
(787) 763-9190

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2658 PR Primary

Addresses

Primary practice location

255 Calle Eleonor Roosevelt
San Juan, PR 00918-2806

Mailing address

PO Box 195015
San Juan, PR 00919-5015
Phone (787) 763-9190

Other identifiers 1

IdentifierTypeStateIssuer
1497721310OtherPRNPI

National Provider Directory

National Provider Directory

Locations

255 Calle Eleonor Roosevelt
San Juan, PR 00918
Phone (787) 763-9190

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1458000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458000000000",
    "number": "1417318684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 195015",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009195015",
            "telephone_number": "787-763-9190",
            "fax_number": "787-763-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 CALLE ELEONOR ROOSEVELT",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009182806",
            "telephone_number": "787-763-9190",
            "fax_number": "787-763-9587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MG DENTAL CARE P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-15",
        "last_updated": "2016-03-15",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "MARDILY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-763-9190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "2658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1497721310",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.