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General NPI Number Information
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NPI Number | 1780024620
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Entity Type | Individual
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Provider Name | JONATHAN CHOURAQUI D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 3401 N FEDERAL HWY STE 101
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City | BOCA RATON
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State | FL
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Zip | 33431-6005
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Country | US
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Telephone | 561-750-6790
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Fax |
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Provider Business Mailing Address
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Address Line | 20505 E COUNTRY CLUB DR APT 1931
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City | AVENTURA
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State | FL
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Zip | 33180-3040
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Country | US
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Telephone | 954-608-1847
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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 | DN20472
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License Number State | FL
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