Basic Information
| Provider Information | |||||||||
| NPI: | 1366883548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAVARRO | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | RAFAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 BROKEN SOUND PKWY STE 250 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619999650 | ||||||||
| FaxNumber: | 5614318169 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 EAST ALTAMONTE DRIVE | ||||||||
| Address2: | SUITE 1020 | ||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076913908 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2013 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 058492-1 | NY | N | Dental Providers | Dentist | Pediatric Dentistry | 122300000X | DN014539 | NY | N | Dental Providers | Dentist | 1223X0400X | DN23158 | FL | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.