Provider Demographics
NPI:1477154045
Name:CORTEZ, JUAN MICHAEL
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MICHAEL
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-077 WAIKALUA RD APT A
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2768
Mailing Address - Country:US
Mailing Address - Phone:541-324-7500
Mailing Address - Fax:
Practice Address - Street 1:1101 5TH ST
Practice Address - Street 2:BLDG 6905
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-257-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6639124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist