Provider Demographics
NPI:1083681191
Name:JUAMBELTZ, JOSE CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:JUAMBELTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 JUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054
Mailing Address - Country:US
Mailing Address - Phone:410-451-1879
Mailing Address - Fax:
Practice Address - Street 1:2880 DUNKIRK WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754
Practice Address - Country:US
Practice Address - Phone:301-855-8888
Practice Address - Fax:410-257-7676
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry