Provider Demographics
NPI:1336530260
Name:NAVARRETE, HANSEL
Entity Type:Individual
Prefix:
First Name:HANSEL
Middle Name:
Last Name:NAVARRETE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MICHIGAN AVE APT 509
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4851
Mailing Address - Country:US
Mailing Address - Phone:786-718-0025
Mailing Address - Fax:
Practice Address - Street 1:1000 MICHIGAN AVE APT 509
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4851
Practice Address - Country:US
Practice Address - Phone:786-718-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist