Provider Demographics
NPI:1649212796
Name:GELDRES, JUANA M (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JUANA
Middle Name:M
Last Name:GELDRES
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:M
Other - Last Name:GELDRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1911 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406
Mailing Address - Country:US
Mailing Address - Phone:561-439-7400
Mailing Address - Fax:561-439-7443
Practice Address - Street 1:1911 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:561-439-7400
Practice Address - Fax:561-439-7443
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN161691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007523100Medicaid