Provider Demographics
NPI:1053432526
Name:BAYAMN DENTAL CLINIC CORPORATION
Entity type:Organization
Organization Name:BAYAMN DENTAL CLINIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:787-798-8488
Mailing Address - Street 1:P5 CALLE C
Mailing Address - Street 2:P 5 CALLE C
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-1660
Mailing Address - Country:US
Mailing Address - Phone:787-638-1962
Mailing Address - Fax:787-779-2707
Practice Address - Street 1:28 CALLE PALMER
Practice Address - Street 2:28 CALLE PALMER
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6334
Practice Address - Country:US
Practice Address - Phone:787-798-8488
Practice Address - Fax:787-779-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty