Basic Information
| Provider Information | |||||||||
| NPI: | 1003804857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUAN | ||||||||
| FirstName: | RENE | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 CALLE PEDRO SANTOS | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006764015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878775865 | ||||||||
| FaxNumber: | 7878775865 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 CALLE PEDRO SANTOS | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006764015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878775865 | ||||||||
| FaxNumber: | 7878775865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 001133 | PR | Y | Dental Providers | Dentist | 122300000X | 0011826 | FL | N | Dental Providers | Dentist |
No ID Information.