Provider Demographics
NPI:1710459573
Name:AMAYA, JUAN ANDRES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANDRES
Last Name:AMAYA
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 1:1045 WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-1449
Mailing Address - Country:US
Mailing Address - Phone:386-624-6685
Mailing Address - Fax:
Practice Address - Street 1:1045 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-1449
Practice Address - Country:US
Practice Address - Phone:386-624-6685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7654122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist