Healthcare Provider Details

I. General information

NPI: 1629192786
Provider Name (Legal Business Name): JUAN CARLOS ARROYO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 PEMBROKE RD STE 314
MIRAMAR FL
33027-2544
US

IV. Provider business mailing address

1836 HARBOR VIEW CIR
WESTON FL
33327-1338
US

V. Phone/Fax

Practice location:
  • Phone: 954-859-5473
  • Fax:
Mailing address:
  • Phone: 954-205-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: