Provider Demographics
NPI:1205115086
Name:JUAN, VERONICA (RDH)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:JUAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5968 SW 163 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193
Mailing Address - Country:US
Mailing Address - Phone:407-803-2904
Mailing Address - Fax:
Practice Address - Street 1:1248 STONE HARBOUR RD.
Practice Address - Street 2:
Practice Address - City:WINTER SPRING
Practice Address - State:FL
Practice Address - Zip Code:32708
Practice Address - Country:US
Practice Address - Phone:407-803-2904
Practice Address - Fax:305-386-4777
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH11123124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist