Organization
IDENTAL CENTER, PROFESSIONAL DENTISTRY, CSP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAYRA CRISTINA GOMEZ DMD (PRESIDENT)
(787) 266-3140
Entity
Organization
Contact information
Practice address
URBANIZACION VILLA HILDA, A5 STREET 1, YABUCOA, PR 00767
(787) 266-3140
(787) 893-3922
Mailing address
PO BOX 1198, LAS PIEDRAS, PR 00771-1198
(787) 266-3140
(787) 893-3922
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2680
PR
Other
Enumeration date
03/13/2007
Last updated
08/22/2020
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