Individual provider Active NPI

Mardily Gonzalez, D.M.D.

  • General Practice Dentistry
  • San Juan, PR
National Provider Identifier
1497721310
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2658 Issued in PR
Practice address
255 Calle Eleonor Roosevelt
San Juan, PR 00918-2806
Phone
(787) 763-9190
Fax
(787) 763-9587
NPI assigned
Feb 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 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

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160308001916 PR Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 9739485343

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2658PRMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
MG Dental Care P.S.C. General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1497721310",
    "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": {
        "last_name": "GONZALEZ",
        "first_name": "MARDILY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "2658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.