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Individual
DR. JOSE RICARDO BURGOS POLO
Active
Individual
DR. JOSE RICARDO BURGOS POLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
02586
PR
122300000X
Dentist
Primary
DN27318
FL
1223G0001X
General Practice Dentistry
DTC18
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003690900
—
FL
01
—
41079BU
SSS PROVIDER
PR
01
—
660427801F3
MCS ADVANTAGE
PR
01
—
70338A
PREFERED MEDICAL CHOICE
PR
01
—
7082
INTERNATIONAL MEDICAL CAR
PR
01
—
DTC-168
FLORIDA STATE DENTAL TEMPORARY CERTIFICATE
FL
01
—
DTC18
FLORIDA DENTAL TEMPORARY CERTIFICATE
FL
Enumeration date
09/26/2005
Last updated
02/14/2023
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