MEDICARE: DR. RENE DAVID JUAN D.D.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	001133	PR
2	122300000X	Dentist	0011826	FL

General Provider Information

NPI Number	:	1003804857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENE DAVID JUAN D.D.M.

Provider Business Mailing Address
First Line	:	65 CALLE PEDRO SANTOS
Second Line	:	SUITE 3
City	:	MOCA
State	:	PR
Zip	:	00676-4015
Country	:	US
Telephone Number	:	787-877-5865
Fax Number	:	787-877-5865

Provider Business Practice Location Address
First Line	:	65 CALLE PEDRO SANTOS
Second Line	:	SUITE 3
City	:	MOCA
State	:	PR
Zip	:	00676-4015
Country	:	US
Telephone Number	:	787-877-5865
Fax Number	:	787-877-5865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/08/2007

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