Provider Demographics
NPI:1609162478
Name:JUANA M GELDRES DDS PA
Entity Type:Organization
Organization Name:JUANA M GELDRES DDS PA
Other - Org Name:DENTIST/GENERAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GELDRES
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-439-7400
Mailing Address - Street 1:1800 FOREST HILL BLVD STE A-3&A4
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6094
Mailing Address - Country:US
Mailing Address - Phone:561-439-7400
Mailing Address - Fax:561-439-7443
Practice Address - Street 1:1800 FOREST HILL BLVD STE A-3&A4
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6094
Practice Address - Country:US
Practice Address - Phone:561-439-7400
Practice Address - Fax:561-439-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16169261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076071400Medicaid