Provider Demographics
NPI:1275672453
Name:JUAREZ, PATRICIA I (DMD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:I
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:I
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2 CAMEO RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2017
Mailing Address - Country:US
Mailing Address - Phone:631-462-1818
Mailing Address - Fax:631-462-1818
Practice Address - Street 1:8 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-928-8585
Practice Address - Fax:631-928-8861
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0494521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02428339Medicaid