Healthcare Provider Details

I. General information

NPI: 1306679931
Provider Name (Legal Business Name): JUAN PABLO ROVIRA GONZALEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ARTHUR GODFREY RD STE 502
MIAMI FL
33140-3500
US

IV. Provider business mailing address

2220 NE 2ND AVE APT 802
MIAMI FL
33137-5480
US

V. Phone/Fax

Practice location:
  • Phone: 305-542-7168
  • Fax:
Mailing address:
  • Phone: 305-954-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN29560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: