Provider Demographics
NPI:1083237903
Name:JUAN DIEGO CARDENAS DDS INC.
Entity Type:Organization
Organization Name:JUAN DIEGO CARDENAS DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-301-0463
Mailing Address - Street 1:7775 SW 87TH AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2536
Mailing Address - Country:US
Mailing Address - Phone:305-598-9072
Mailing Address - Fax:305-239-9310
Practice Address - Street 1:7775 SW 87TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2536
Practice Address - Country:US
Practice Address - Phone:305-598-9072
Practice Address - Fax:305-239-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental