Healthcare Provider Details

I. General information

NPI: 1740480995
Provider Name (Legal Business Name): JUAN HARO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BEACH ST
WATSONVILLE CA
95076-4809
US

IV. Provider business mailing address

45 NIELSON ST
WATSONVILLE CA
95076-2468
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-3413
  • Fax: 831-728-8257
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-728-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: