Healthcare Provider Details

I. General information

NPI: 1083681191
Provider Name (Legal Business Name): JOSE CARLOS JUAMBELTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 DUNKIRK WAY STE 104
DUNKIRK MD
20754-2024
US

IV. Provider business mailing address

PO BOX 219
DUNKIRK MD
20754-0219
US

V. Phone/Fax

Practice location:
  • Phone: 410-257-7676
  • Fax: 410-257-5212
Mailing address:
  • Phone: 410-271-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11030
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: