Provider Demographics
NPI:1558511493
Name:JUSINO, MIGUEL ANGEL (DMD, MS)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:JUSINO
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6841 LIVINGSTON WOODS LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3835
Mailing Address - Country:US
Mailing Address - Phone:787-431-7479
Mailing Address - Fax:239-301-2611
Practice Address - Street 1:28901 TRAILS EDGE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7588
Practice Address - Country:US
Practice Address - Phone:239-913-6780
Practice Address - Fax:239-301-2611
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN231541223P0300X
PR2824122300000X
PR1259801223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist