Provider Demographics
NPI:1316135205
Name:FIGUEROA, FERNANDO LUIS (DDS)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
Last Name:FIGUEROA
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 1:4750 JOG RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5119
Mailing Address - Country:US
Mailing Address - Phone:561-432-1718
Mailing Address - Fax:561-432-1748
Practice Address - Street 1:4750 JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-5119
Practice Address - Country:US
Practice Address - Phone:561-432-1718
Practice Address - Fax:561-432-1748
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice