Individual
JUANITA AVENA LOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
51 E 42ND ST, NEW YORK, NY 10017-5404
(212) 856-9465
Mailing address
51 E 42ND ST, NEW YORK, NY 10017-5404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
043708-1
NY
Other
Enumeration date
12/17/2010
Last updated
12/17/2010
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