MEDICARE: DR. JUAN CARLOS GIRALDO DMD

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	1223G0001X	General Practice Dentistry	DN18134	FL

General Provider Information

NPI Number	:	1568652105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS GIRALDO DMD

Provider Business Mailing Address
First Line	:	1497 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6052
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1497 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6052
Country	:	US
Telephone Number	:	561-964-4699
Fax Number	:	561-965-8437

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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