Provider Demographics
NPI:1073184255
Name:COBO, JUAN FERNANDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:FERNANDO
Last Name:COBO
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 1:400 SW 101ST TER UNIT 208
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1095
Mailing Address - Country:US
Mailing Address - Phone:305-890-9585
Mailing Address - Fax:
Practice Address - Street 1:400 SW 101ST TER UNIT 208
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1095
Practice Address - Country:US
Practice Address - Phone:305-890-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL263331223G0001X
FLDN268701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice