Healthcare Provider Details

I. General information

NPI: 1649212796
Provider Name (Legal Business Name): JUANA M GELDRES DDS, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUANA M GELDRES DDS

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 FOREST HILL BLVD
WEST PALM BEACH FL
33406
US

IV. Provider business mailing address

1911 FOREST HILL BLVD
WEST PALM BEACH FL
33406
US

V. Phone/Fax

Practice location:
  • Phone: 561-439-7400
  • Fax: 561-439-7443
Mailing address:
  • Phone: 561-439-7400
  • Fax: 561-439-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN16169
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: