MEDICARE: JUAN C FABREGA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN 21137	FL

General Provider Information

NPI Number	:	1215326830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN C FABREGA DMD

Provider Business Mailing Address
First Line	:	18134 POWELL RD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-8141
Country	:	US
Telephone Number	:	352-848-1050
Fax Number	:	352-848-1094

Provider Business Practice Location Address
First Line	:	18134 POWELL RD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-8141
Country	:	US
Telephone Number	:	352-848-1050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	04/10/2019

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