Healthcare Provider Details

I. General information

NPI: 1760597306
Provider Name (Legal Business Name): JOAQUIN ZAGARRA DDS, MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6991 W BROWARD BLVD SUITE 101
PLANTATION FL
33317-2907
US

IV. Provider business mailing address

6991 W BROWARD BLVD SUITE 101
PLANTATION FL
33317-2907
US

V. Phone/Fax

Practice location:
  • Phone: 954-321-5600
  • Fax: 954-316-4433
Mailing address:
  • Phone: 954-321-5600
  • Fax: 954-316-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN17468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: