MEDICARE: EFREN NATHAN JUAREZ D.D.S.

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	1223G0001X	General Practice Dentistry	49554	CA

General Provider Information

NPI Number	:	1235134107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EFREN NATHAN JUAREZ D.D.S.

Provider Business Mailing Address
First Line	:	701 W VALLEY BLVD
Second Line	:	STE 76
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-3243
Country	:	US
Telephone Number	:	626-289-9075
Fax Number	:	626-289-9076

Provider Business Practice Location Address
First Line	:	701 W VALLEY BLVD
Second Line	:	STE 76
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-3243
Country	:	US
Telephone Number	:	626-289-9075
Fax Number	:	626-289-9076

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/08/2012

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