Provider Demographics
NPI:1144955493
Name:JUAREZ, ARIEL ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:ROSE
Last Name:JUAREZ
Suffix:
Gender:F
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:PO BOX 1193
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96767-1193
Mailing Address - Country:US
Mailing Address - Phone:909-800-3879
Mailing Address - Fax:
Practice Address - Street 1:40 KUPUOHI ST STE 201
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2714
Practice Address - Country:US
Practice Address - Phone:808-661-8126
Practice Address - Fax:808-824-3524
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-3007-01223G0001X
CADDS1087001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice