Provider Demographics
NPI:1043253248
Name:MATOS-ROBLES, JUAN ROBERTO (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ROBERTO
Last Name:MATOS-ROBLES
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:500 AVE COMERIO
Mailing Address - Street 2:DAVISON PLAZA #3
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4060
Mailing Address - Country:US
Mailing Address - Phone:787-261-1370
Mailing Address - Fax:787-784-8383
Practice Address - Street 1:500 AVE COMERIO
Practice Address - Street 2:DAVISON PLAZA #3
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4060
Practice Address - Country:US
Practice Address - Phone:787-261-1370
Practice Address - Fax:787-784-8383
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice