Individual provider Active NPI

Samantha Ordaz Moguel, DMD

  • Prosthodontics
  • San Juan, PR
National Provider Identifier
1962038422
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
3386 Issued in PR
Practice address
255 Calle Eleonor Roosevelt
San Juan, PR 00918-2806
Phone
(787) 763-9190
NPI assigned
Mar 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 3386 PR Primary

Addresses

Primary practice location

255 Calle Eleonor Roosevelt
San Juan, PR 00918-2806

Mailing address

88 Calle Zeus
Guayama, PR 00784-6661

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
I20231206001274 PR Practitioner - Dentist 0547619314 Practice locations: San Juan, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3386PRMDProsthodontist
003386PRMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MG Dental Care P.S.C. PastSince Dec 3, 2023 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": "1584403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701302400000",
    "number": "1962038422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 CALLE ZEUS",
            "city": "GUAYAMA",
            "state": "PR",
            "postal_code": "007846661"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORDAZ MOGUEL",
        "first_name": "SAMANTHA",
        "name_prefix": "Ms.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-17",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "PR",
            "license": "3386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.