MEDICARE: CHRISTIAN DE JESUS D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN 18028	FL

General Provider Information

NPI Number	:	1821308073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN DE JESUS D.M.D.

Provider Business Mailing Address
First Line	:	8541 NW 7TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6635
Country	:	US
Telephone Number	:	305-587-6103
Fax Number	:

Provider Business Practice Location Address
First Line	:	11445 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3311
Country	:	US
Telephone Number	:	305-428-2797
Fax Number	:	305-428-2634

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

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	07/21/2022

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