Provider Demographics
NPI:1255857801
Name:NAMEN ALARCON, JAVIER SALMEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:SALMEN
Last Name:NAMEN ALARCON
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 1:173 N MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5026
Mailing Address - Country:US
Mailing Address - Phone:786-262-5174
Mailing Address - Fax:
Practice Address - Street 1:173 N MELROSE DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5026
Practice Address - Country:US
Practice Address - Phone:786-262-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRP18251223D0001X
FLDH19582124Q00000X
FLDN25148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223D0001XDental ProvidersDentistDental Public Health
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0022113000Medicaid