Individual provider Active NPI

Jose F. Perez Moll, D.M.D.

  • Prosthodontics
  • Bayamon, PR
National Provider Identifier
1720291685
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
805 Issued in PR
Practice address
191 Ave Betances
Hermanas Davila
Bayamon, PR 00959-5159
Phone
(787) 798-4083
NPI assigned
May 8, 2007
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
Prosthodontics 1223P0700X 805 PR Primary

Addresses

Primary practice location

191 Ave Betances
Hermanas Davila
Bayamon, PR 00959-5159

Mailing address

191 Ave Betances
Hermanas Davila
Bayamon, PR 00959-5159
Phone (787) 798-4083

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
I20200226000789 PR Practitioner - Dentist 6204263569 Practice locations: Bayamon, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
805PRMDProsthodontist
000805PRMDOptician

NPI Registry JSON

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720291685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 AVE BETANCES",
            "address_2": "HERMANAS DAVILA",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009595159",
            "telephone_number": "787-798-4083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 AVE BETANCES",
            "address_2": "HERMANAS DAVILA",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009595159",
            "telephone_number": "787-798-4083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ MOLL",
        "first_name": "JOSE",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "PR",
            "license": "805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayamon, PR

Sources for this page

Verify at the official NPI Registry.