Provider Demographics
NPI:1831291236
Name:APONTE, JUAN R (DDS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:R
Last Name:APONTE
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 1:125 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4795
Mailing Address - Country:US
Mailing Address - Phone:931-484-7650
Mailing Address - Fax:207-374-3810
Practice Address - Street 1:125 BROWN AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4795
Practice Address - Country:US
Practice Address - Phone:931-484-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME35721223G0001X
TN00000115111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133650000Medicaid
ME294110099OtherMAINE CARE