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General NPI Number Information
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NPI Number | 1821308073
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Entity Type | Individual
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Provider Name | CHRISTIAN DE JESUS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11445 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3311
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Country | US
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Telephone | 305-428-2797
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Fax | 305-428-2634
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Provider Business Mailing Address
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Address Line | 8541 NW 7TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6635
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Country | US
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Telephone | 305-587-6103
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN 18028
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License Number State | FL
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