Keisy Bonano Baez, BS
Individual provider Active NPI General Practice Dentistry · San Juan, PR
NPI 1801523840 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1801523840
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3501 (PR)
- Practice address
- 200 Carr 842
Apt. P101
San Juan, PR 00926 - Phone
- (787) 223-1776
- NPI assigned
- Aug 1, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240805004197 | PR | Practitioner - Dentist | 9032656277 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3501 | PR | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Olaf Group LLC | Current |
Accepting new patients |
Locations
551 Ave Escorial
San Juan, PR 00920
Phone (787) 782-0403
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Dentistry | 1223G0001X | 3501 | PR | Yes |
Addresses
Primary practice location
200 Carr 842
Apt. P101
San Juan, PR 00926
Mailing address
200 Carr 842 Box105
Apt. P101
San Juan, PR 00926
Phone (787) 223-1776
Other providers in San Juan, PR
- Sergio Bogoljubskij
- Cynthia Bojito
- Orlando Bolet
- Laura Mercedes Bolorin Vargas
- Fernando Bonafoux
- Doris V Bonano
- Juan F Bonano
- Bone Logix
- Andrea Sofia Boneo
- Eric Jose Bones Santiago
All providers in San Juan, PR · General Practice Dentistry in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.