Healthcare Provider Details

I. General information

NPI: 1255299442
Provider Name (Legal Business Name): JUAN EMILIO MONTIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 NW 107TH AVE
DORAL FL
33178-4852
US

IV. Provider business mailing address

4201 NW 107TH AVE
DORAL FL
33178-4852
US

V. Phone/Fax

Practice location:
  • Phone: 305-594-4418
  • Fax:
Mailing address:
  • Phone: 305-594-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: