Juan M Teodoro, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN17032 Issued in FL

Practice address

9510 Bonita Beach Rd SE
Suite 102
Bonita Springs, FL 34135-4699

Phone

(239) 333-4343

Fax

(239) 333-4344

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282262400000",
    "number": "1194899435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9510 BONITA BEACH RD SE",
            "address_2": "SUITE 102",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354699",
            "telephone_number": "239-333-4343",
            "fax_number": "239-333-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9510 BONITA BEACH RD SE",
            "address_2": "SUITE 102",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354699",
            "telephone_number": "239-333-4343",
            "fax_number": "239-333-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEODORO",
        "first_name": "JUAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2010-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN17032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.