| Organization Name: | CLINICA DENTAL MIRMAR INC |
| NPI Number: | 1063530111 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MIRELIS NYVETTE COLON (PRESIDENT) |
| Mailing Address: | 120 Calle Georgetti Naranjito |
| State: | PR US |
| Postal Code: | 007193011 |
| Phone Number: | 7878692565 |
| Fax Number: | 7878692471 |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2675 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |