Provider Demographics
NPI:1285219998
Name:DE LA BARCA SUAREZ, JAVIER ENRIQUE (DOCTOR OF DENTISTRY)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:ENRIQUE
Last Name:DE LA BARCA SUAREZ
Suffix:
Gender:M
Credentials:DOCTOR OF DENTISTRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4780
Mailing Address - Country:US
Mailing Address - Phone:786-720-0941
Mailing Address - Fax:
Practice Address - Street 1:750 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3817
Practice Address - Country:US
Practice Address - Phone:305-694-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLDRPM2274390200000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37012336OtherUNIVERSITY OF FLORIDA