Provider Demographics
NPI:1649506213
Name:PEGUERO, OSCAR JESUS JR (DMD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:JESUS
Last Name:PEGUERO
Suffix:JR
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 1:7000 SW 62ND AVE
Mailing Address - Street 2:PENTHOUSE-E
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4716
Mailing Address - Country:US
Mailing Address - Phone:305-666-6104
Mailing Address - Fax:305-665-1136
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:PENTHOUSE-E
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-666-6104
Practice Address - Fax:305-665-1136
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN188261223E0200X
MADN18552561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics