Healthcare Provider Details

I. General information

NPI: 1972874519
Provider Name (Legal Business Name): CESAR F HURTADO JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 12/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9463 W FLAGLER ST
MIAMI FL
33174-2010
US

IV. Provider business mailing address

9463 W FLAGLER ST
MIAMI FL
33174-2010
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-1555
  • Fax: 305-226-7669
Mailing address:
  • Phone: 305-444-1555
  • Fax: 305-226-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10614
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 20027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: