Individual
JUAN CARLOS PORTELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6222 MYRTLE AVE, GLENDALE, NY 11385-6236
(718) 821-7432
Mailing address
4545 CENTER BLVD APT 2908, LONG ISLAND CITY, NY 11109-5960
(347) 924-7736
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
053665
NY
Other
Enumeration date
10/09/2007
Last updated
02/16/2016
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