Provider Demographics
NPI:1043382138
Name:GARRASTAZU, JUAN LUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:LUIS
Last Name:GARRASTAZU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10717 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2801
Mailing Address - Country:US
Mailing Address - Phone:305-513-4058
Mailing Address - Fax:305-639-2931
Practice Address - Street 1:10717 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178
Practice Address - Country:US
Practice Address - Phone:305-513-4058
Practice Address - Fax:305-639-2931
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist