Provider Demographics
NPI:1821308073
Name:DE JESUS, CHRISTIAN (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:DE JESUS
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 1:8541 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6635
Mailing Address - Country:US
Mailing Address - Phone:305-587-6103
Mailing Address - Fax:
Practice Address - Street 1:11445 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3311
Practice Address - Country:US
Practice Address - Phone:305-428-2797
Practice Address - Fax:305-428-2634
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 180281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics