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General NPI Number Information
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NPI Number | 1104264910
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Entity Type | Individual
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Provider Name | RICARDO JOSE HUMARAN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 01/21/2017
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Provider Practice Location Address
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Address Line | 15495 EAGLE NEST LN STE 200
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2255
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Country | US
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Telephone | 305-699-3093
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Fax | 786-870-4909
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Provider Business Mailing Address
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Address Line | 7512 NW 176TH ST
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City | HIALEAH
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State | FL
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Zip | 33015-7153
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Country | US
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Telephone | 786-554-3751
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN20129
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License Number State | FL
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