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General NPI Number Information
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NPI Number | 1003804857
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Entity Type | Individual
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Provider Name | RENE DAVID JUAN D.D.M.
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Gender | Male
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 65 CALLE PEDRO SANTOS SUITE 3
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City | MOCA
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State | PR
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Zip | 00676-4015
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Country | US
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Telephone | 787-877-5865
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Fax | 787-877-5865
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Provider Business Mailing Address
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Address Line | 65 CALLE PEDRO SANTOS SUITE 3
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City | MOCA
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State | PR
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Zip | 00676-4015
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Country | US
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Telephone | 787-877-5865
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Fax | 787-877-5865
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 001133
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0011826
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License Number State | FL
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