Provider Demographics
NPI:1235134107
Name:JUAREZ, EFREN NATHAN (DDS)
Entity Type:Individual
Prefix:
First Name:EFREN
Middle Name:NATHAN
Last Name:JUAREZ
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 1:701 W VALLEY BLVD
Mailing Address - Street 2:STE 76
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3243
Mailing Address - Country:US
Mailing Address - Phone:626-289-9075
Mailing Address - Fax:626-289-9076
Practice Address - Street 1:701 W VALLEY BLVD
Practice Address - Street 2:STE 76
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3243
Practice Address - Country:US
Practice Address - Phone:626-289-9075
Practice Address - Fax:626-289-9076
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice