Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 001133 | PR |
N | 122300000X | Dentist | 0011826 | FL |
NPI | 1003804857 |
---|---|
Provider Name | Dr. Rene David Juan |
First Address | Moca, PR 00676-4015 |
Second Address | Moca, PR 00676-4015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 08/07/2007 |