Provider Demographics
NPI:1700915089
Name:MAYSONET, JUAN CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:MAYSONET
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:AX2 CALLE 1
Mailing Address - Street 2:PRADERA NORTE
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3693
Mailing Address - Country:US
Mailing Address - Phone:787-795-3427
Mailing Address - Fax:787-795-5843
Practice Address - Street 1:AX2 CALLE 1
Practice Address - Street 2:PRADERA NORTE
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3693
Practice Address - Country:US
Practice Address - Phone:787-795-3427
Practice Address - Fax:787-795-5843
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD2283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist