Provider Demographics
NPI:1467009019
Name:MOSQUEDA JUNCO, MAYLIN (DMD)
Entity Type:Individual
Prefix:
First Name:MAYLIN
Middle Name:
Last Name:MOSQUEDA JUNCO
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 1:9 ANTHONY CIR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1750
Mailing Address - Country:US
Mailing Address - Phone:954-696-7476
Mailing Address - Fax:
Practice Address - Street 1:210 AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1726
Practice Address - Country:US
Practice Address - Phone:732-826-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN241011223G0001X
NJDI277281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty