Provider Demographics
NPI:1881615359
Name:BIRD, JUAN CARLOS (DMD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:BIRD
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 1:10249 SW 162ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5892
Mailing Address - Country:US
Mailing Address - Phone:305-386-2713
Mailing Address - Fax:
Practice Address - Street 1:401 MIRACLE MILE STE 411
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4926
Practice Address - Country:US
Practice Address - Phone:305-648-9190
Practice Address - Fax:305-648-9191
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice