NPIMap

Organization Active NPI

Grupo Dental Pediatrico San Juan CSP

  • Pediatric Dentistry
  • San Juan, PR
National Provider Identifier
1700299104
Registry record updated Jun 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
618 Issued in PR
Legal business name
GRUPO DENTAL PEDIATRICO SAN JUAN CSP
Practice address
576 Ave Cesar Gonzalez Suite 307
Grupo Dental Pediatrico Doral Bank Center
San Juan, PR 00918-0000
Phone
(787) 753-1405
Fax
(787) 753-1475
NPI assigned
Jun 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2014

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

Authorized official

Name
Mrs. Yilda M Rivera I, DMD
Title
President
Phone
(787) 753-1475

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 2767 PR
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 618 PR Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 2472 PR
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 2841 PR

Addresses

Primary practice location

576 Ave Cesar Gonzalez Suite 307
Grupo Dental Pediatrico Doral Bank Center
San Juan, PR 00918-0000

Mailing address

576 Ave Cesar Gonzalez Suite 307
Grupo Dental Pediatrico Doral Bank Center
San Juan, PR 00918-0000
Phone (787) 753-1405

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1401840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401840000000",
    "number": "1700299104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 AVE CESAR GONZALEZ SUITE 307",
            "address_2": "GRUPO DENTAL PEDIATRICO DORAL BANK CENTER",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009180000",
            "telephone_number": "787-753-1405",
            "fax_number": "787-753-1475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 AVE CESAR GONZALEZ SUITE 307",
            "address_2": "GRUPO DENTAL PEDIATRICO DORAL BANK CENTER",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009180000",
            "telephone_number": "787-753-1405",
            "fax_number": "787-753-1475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRUPO DENTAL PEDIATRICO SAN JUAN CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-04",
        "last_updated": "2014-06-04",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "YILDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-753-1475",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PR",
            "license": "2767",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PR",
            "license": "618",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PR",
            "license": "2472",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PR",
            "license": "2841",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Jun 4, 2014; 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.