Provider Demographics
NPI:1306864509
Name:CONCEPCION, JORGE R (DDS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:R
Last Name:CONCEPCION
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 1:13310 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1100
Mailing Address - Country:US
Mailing Address - Phone:305-510-5479
Mailing Address - Fax:
Practice Address - Street 1:11944 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1672
Practice Address - Country:US
Practice Address - Phone:305-221-5112
Practice Address - Fax:305-221-5640
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 15638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist