Provider Demographics
NPI:1548270184
Name:NARVAEZ, JOSE ANTONIO VILLALOBOS (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE ANTONIO
Middle Name:VILLALOBOS
Last Name:NARVAEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68 NE 167TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3401
Mailing Address - Country:US
Mailing Address - Phone:305-647-6453
Mailing Address - Fax:305-947-6453
Practice Address - Street 1:68 NE 167TH ST STE B
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3401
Practice Address - Country:US
Practice Address - Phone:305-647-6453
Practice Address - Fax:305-947-6453
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN131341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073965100Medicaid