Provider Demographics
NPI:1306406772
Name:MENESES, JULEINI M (DMD)
Entity Type:Individual
Prefix:
First Name:JULEINI
Middle Name:M
Last Name:MENESES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 W 24TH AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6993
Mailing Address - Country:US
Mailing Address - Phone:786-623-8065
Mailing Address - Fax:
Practice Address - Street 1:2526 E BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5069
Practice Address - Country:US
Practice Address - Phone:813-553-7120
Practice Address - Fax:813-553-7121
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN248251223G0001X
NMDD5113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist