Provider Demographics
NPI:1518938992
Name:HADDOCK, FERNANDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:HADDOCK
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 1:30 CALLE JUAN C BORBON
Mailing Address - Street 2:APT. 422
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5316
Mailing Address - Country:US
Mailing Address - Phone:787-749-4047
Mailing Address - Fax:787-706-2802
Practice Address - Street 1:30 CALLE JUAN C BORBON
Practice Address - Street 2:APT. 422
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5316
Practice Address - Country:US
Practice Address - Phone:787-749-4047
Practice Address - Fax:787-706-2802
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice