Provider Demographics
NPI:1023120813
Name:MATERON, JUAN C (DDS)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:C
Last Name:MATERON
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 1:11275 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3263
Mailing Address - Country:US
Mailing Address - Phone:720-440-2233
Mailing Address - Fax:303-557-6102
Practice Address - Street 1:11275 E MISSISSIPPI AVE STE 1E3
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2818
Practice Address - Country:US
Practice Address - Phone:720-440-2233
Practice Address - Fax:303-557-6102
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02075687Medicaid