Provider Demographics
NPI:1669637070
Name:CAMARENA, JUAN ALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ALBERTO
Last Name:CAMARENA
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 1:314 N MADERA PRIVADO
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5640
Mailing Address - Country:US
Mailing Address - Phone:562-212-3727
Mailing Address - Fax:
Practice Address - Street 1:452 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2540
Practice Address - Country:US
Practice Address - Phone:909-983-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice