Provider Demographics
NPI:1194899435
Name:TEODORO, JUAN M (DMD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:TEODORO
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 1:9510 BONITA BEACH RD SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4699
Mailing Address - Country:US
Mailing Address - Phone:239-333-4343
Mailing Address - Fax:239-333-4344
Practice Address - Street 1:9510 BONITA BEACH RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4699
Practice Address - Country:US
Practice Address - Phone:239-333-4343
Practice Address - Fax:239-333-4344
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN170321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics