Provider Demographics
NPI:1972906550
Name:SAN JUAN, FERNANDO ORESTES JR (DMD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ORESTES
Last Name:SAN JUAN
Suffix:JR
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 SE HAMPSHIRE WAY APT 201
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5770
Mailing Address - Country:US
Mailing Address - Phone:305-308-7335
Mailing Address - Fax:
Practice Address - Street 1:840 US 1 STE 350
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3834
Practice Address - Country:US
Practice Address - Phone:561-694-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist