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General NPI Number Information
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NPI Number | 1194899435
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Entity Type | Individual
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Provider Name | JUAN M TEODORO DMD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 9510 BONITA BEACH RD SE SUITE 102
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4699
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Country | US
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Telephone | 239-333-4343
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Fax | 239-333-4344
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Provider Business Mailing Address
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Address Line | 9510 BONITA BEACH RD SE SUITE 102
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4699
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Country | US
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Telephone | 239-333-4343
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Fax | 239-333-4344
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN17032
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License Number State | FL
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