Provider Demographics
NPI:1023465366
Name:ECHEVARRIA, JAVIER ENRIQUE (DMD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:ENRIQUE
Last Name:ECHEVARRIA
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 1:4021 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1623
Mailing Address - Country:US
Mailing Address - Phone:863-356-0329
Mailing Address - Fax:
Practice Address - Street 1:4021 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1623
Practice Address - Country:US
Practice Address - Phone:863-356-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
FLDN238491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program