Individual provider Active NPI

Milton Irizarry, DMD

  • General Practice Dentistry
  • San Juan, PR
National Provider Identifier
1679565154
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
798 Issued in PR
Practice address
925 Ave de Diego
La Riviera
San Juan, PR 00921-2503
Phone
(787) 273-0815
Fax
(787) 277-0060
NPI assigned
Aug 19, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 798 PR Primary

Addresses

Primary practice location

925 Ave de Diego
La Riviera
San Juan, PR 00921-2503

Mailing address

925 Ave de Diego
La Riviera
San Juan, PR 00921-2503
Phone (787) 273-0815

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
I20150715001940 PR Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7416260716

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
798PRMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679565154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 AVE DE DIEGO",
            "address_2": "LA RIVIERA",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009212503",
            "telephone_number": "787-273-0815",
            "fax_number": "787-277-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 AVE DE DIEGO",
            "address_2": "LA RIVIERA",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009212503",
            "telephone_number": "787-273-0815",
            "fax_number": "787-277-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRIZARRY",
        "first_name": "MILTON",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.