=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003487349
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIETA MORALES RUEDA DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2021
-----------------------------------------------------
Last Update Date | 06/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9835 SW 72ND ST STE 209
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-400-9835
-----------------------------------------------------
Fax | 786-796-9699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9835 SW 72ND ST STE 209
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-400-9835
-----------------------------------------------------
Fax | 786-796-9699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN26331
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------