Provider Demographics
NPI:1710298302
Name:QUINTERO, JUAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 SW 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6581
Mailing Address - Country:US
Mailing Address - Phone:305-336-0582
Mailing Address - Fax:
Practice Address - Street 1:11880 SW 40TH ST STE 302
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3574
Practice Address - Country:US
Practice Address - Phone:305-221-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist