Individual
JOSE MANUEL DIVO MATERAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12329 S ORANGE BLOSSOM TRL, ORLANDO, FL 32837-6214
(407) 584-8565
Mailing address
932 LARSON DR, ALTAMONTE SPRINGS, FL 32714-2036
(407) 848-6760
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN31027
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
MA
Other
Enumeration date
01/28/2025
Last updated
10/30/2025
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