Organization
MG DENTAL CARE P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARDILY GONZALEZ D.M.D. (PRESIDENT)
(787) 763-9190
Entity
Organization
Contact information
Practice address
255 CALLE ELEONOR ROOSEVELT, SAN JUAN, PR 00918-2806
(787) 763-9190
(787) 763-9587
Mailing address
PO BOX 195015, SAN JUAN, PR 00919-5015
(787) 763-9190
(787) 763-9587
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2658
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497721310
NPI
PR
Enumeration date
03/15/2016
Last updated
03/15/2016
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