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General NPI Number Information
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NPI Number | 1043382138
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Entity Type | Individual
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Provider Name | JUAN LUIS GARRASTAZU D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 10717 NW 58TH ST
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City | DORAL
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State | FL
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Zip | 33178
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Country | US
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Telephone | 305-513-4058
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Fax | 305-639-2931
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Provider Business Mailing Address
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Address Line | 10717 NW 58TH ST
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City | DORAL
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State | FL
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Zip | 33178-2801
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Country | US
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Telephone | 305-513-4058
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Fax | 305-639-2931
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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 | DN13558
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License Number State | FL
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