Individual
DR. JUAN CARLOS DE FEX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
74-10 35TH AVENUE, SUITE 106W, JACKSON HEIGHTS, NY 11372-8160
(718) 476-6750
(718) 426-4040
Mailing address
74-10 35TH AVENUE, SUITE 106W, JACKSON HEIGHTS, NY 11372-8160
(718) 476-6750
(718) 426-4040
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
043060
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01407450
—
NY
Enumeration date
04/13/2006
Last updated
07/01/2009
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