Healthcare Provider Details

I. General information

NPI: 1326335456
Provider Name (Legal Business Name): ANGEL DAVID JUNQUERA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2011
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7480 BIRD RD. SUITE 500
MIAMI FL
33155
US

IV. Provider business mailing address

7480 BIRD RD. SUITE 500
MIAMI FL
33155
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-8200
  • Fax: 305-256-5280
Mailing address:
  • Phone: 305-551-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: