Provider Demographics
NPI:1831101898
Name:FERNANDEZ, JUAN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FLOR GERENASOUTH
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0427
Mailing Address - Country:US
Mailing Address - Phone:787-852-1520
Mailing Address - Fax:787-850-7582
Practice Address - Street 1:FLOR GERENA #7 SOUTH
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-1520
Practice Address - Fax:787-850-7582
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice