Provider Demographics
NPI:1295808038
Name:COLON, JUAN L (DDS)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:L
Last Name:COLON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CALLE MATTEI LLUBERAS
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3635
Mailing Address - Country:US
Mailing Address - Phone:787-267-0028
Mailing Address - Fax:787-856-2762
Practice Address - Street 1:40 CALLE MATTEI LLUBERAS
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3635
Practice Address - Country:US
Practice Address - Phone:787-267-0028
Practice Address - Fax:787-856-2762
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD020501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7809OtherINTERNATIONAL HEATH PLAN
PR41890OtherSSS OPTIMO
PRDN02050OtherUIA HEALTH PLAN
PR206964OtherPREFERRED HEALTH PLAN
PR26429OtherAMERICAN HEALTH PLAN
PR70075OtherPREFERRED MEDICARE CHOICE
PR41890OtherSSS HEALTH PLAN
PR41902OtherLA CRUZ AZUL HEALTH PLAN
PR7809OtherFIRST PLUS HEALTH PLAN
PR41890OtherCCC HEALTH PLAN
PR6980044OtherHUMANA HEALTH PLAN