Active NPI
Carlos Juan Ponce de Leon, D.D.S.
- Dentist
- Mayaguez, PR
National Provider Identifier
1972710259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2059
- Practice address
- Carretera 105 KM 9 Mayaguez Arriba Sector El Limon
Centro de Detencion del Oeste
Mayaguez, PR 00680 - Phone
- (787) 265-4465
- NPI assigned
- May 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2059 | PR | Primary |
Addresses
Primary practice location
Carretera 105 KM 9 Mayaguez Arriba Sector El Limon
Centro de Detencion del Oeste
Mayaguez, PR 00680
Mailing address
PO Box 1144
Boqueron, PR 00622-1144
Phone (787) 538-1462
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2059 | PR | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972710259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1144",
"city": "BOQUERON",
"state": "PR",
"postal_code": "006221144",
"telephone_number": "787-538-1462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CARRETERA 105 KM 9 MAYAGUEZ ARRIBA SECTOR EL LIMON",
"address_2": "CENTRO DE DETENCION DEL OESTE",
"city": "MAYAGUEZ",
"state": "PR",
"postal_code": "00680",
"telephone_number": "787-265-4465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONCE DE LEON",
"first_name": "CARLOS",
"middle_name": "JUAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PR",
"license": "2059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mayaguez, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.