Provider Demographics
NPI:1679628481
Name:JUAREZ, FELIPE (DMD)
Entity Type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:
Last Name:JUAREZ
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 1:829 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-1601
Mailing Address - Country:US
Mailing Address - Phone:361-241-0437
Mailing Address - Fax:361-241-2055
Practice Address - Street 1:3151 MCKINZIE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-2630
Practice Address - Country:US
Practice Address - Phone:361-241-6622
Practice Address - Fax:361-241-2055
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice