MEDICARE: DR. JUAN CARLOS MARCANO CEBALLOS D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30026674	OH
2	122300000X	Dentist	DN26540	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043411796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS MARCANO CEBALLOS D.D.S

Provider Business Mailing Address
First Line	:	901 VILLAGE BLVD STE 700
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1947
Country	:	US
Telephone Number	:	561-328-6360
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 VILLAGE BLVD STE 700
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1947
Country	:	US
Telephone Number	:	561-328-6360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	02/27/2024

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