Healthcare Provider Details

I. General information

NPI: 1124000575
Provider Name (Legal Business Name): JOHN ROBERT PASQUAL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LINTON BLVD STE 220
DELRAY BEACH FL
33445-6600
US

IV. Provider business mailing address

4600 LINTON BLVD STE 220
DELRAY BEACH FL
33445-6600
US

V. Phone/Fax

Practice location:
  • Phone: 561-900-9080
  • Fax: 561-900-9084
Mailing address:
  • Phone: 561-900-9080
  • Fax: 561-900-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS030473L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN17270
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN17270
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: