Healthcare Provider Details

I. General information

NPI: 1740127406
Provider Name (Legal Business Name): JUAN SIMON BOJANA RIVERO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 W 84TH ST STE 2
HIALEAH FL
33018-4985
US

IV. Provider business mailing address

9367 W 33RD WAY
HIALEAH FL
33018-2053
US

V. Phone/Fax

Practice location:
  • Phone: 786-284-2867
  • Fax:
Mailing address:
  • Phone: 786-284-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: