Provider Demographics
NPI:1760733000
Name:PADRON, FERNANDO J (DDS)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:J
Last Name:PADRON
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 1:2851 SW 71ST TER
Mailing Address - Street 2:APT. # 1116
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1122
Mailing Address - Country:US
Mailing Address - Phone:305-409-9677
Mailing Address - Fax:
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD STE 303
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3771
Practice Address - Country:US
Practice Address - Phone:954-456-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL196371223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics