Provider Demographics
NPI:1104264910
Name:HUMARAN, RICARDO JOSE (DMD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:JOSE
Last Name:HUMARAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 NW 176TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7153
Mailing Address - Country:US
Mailing Address - Phone:786-554-3751
Mailing Address - Fax:
Practice Address - Street 1:15495 EAGLE NEST LN STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2255
Practice Address - Country:US
Practice Address - Phone:305-699-3093
Practice Address - Fax:786-870-4909
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN201291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice