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General NPI Number Information
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NPI Number | 1619661691
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Entity Type | Individual
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Provider Name | JAVIER EDUARDO REBOLLEDO DMD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 2114 W BRANDON BLVD
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City | BRANDON
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State | FL
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Zip | 33511-4704
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Country | US
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Telephone | 813-522-3677
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Fax |
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Provider Business Mailing Address
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Address Line | 12106 CLEARBROOK CT
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City | RIVERVIEW
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State | FL
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Zip | 33569-4104
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Country | US
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Telephone | 239-834-9006
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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 | DN30986
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License Number State | FL
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