Individual
JUAN CARLOS PORTUONDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7150 W 20TH AVE STE 102, HIALEAH, FL 33016-5509
(305) 556-5600
Mailing address
165 W MCINTYRE ST, KEY BISCAYNE, FL 33149-1861
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN 10130
FL
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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