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General NPI Number Information
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NPI Number | 1124419122
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Entity Type | Organization
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Legal Business Name | I DENTAL FAMILY DENTISTRY JUAN C HUAMAN DDS,CORP
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 620 W YOSEMITE AVE
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City | MADERA
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State | CA
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Zip | 93637-4523
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Country | US
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Telephone | 559-673-7700
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Fax | 559-673-7702
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Provider Business Mailing Address
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Address Line | 620 W YOSEMITE AVE
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City | MADERA
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State | CA
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Zip | 93637-4523
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING DR
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Name | DR. JUAN CARLOS HUAMAN
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Credential | DDS
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Telephone | 559-673-7700
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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 | 59160
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License Number State | CA
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