NPI 1053754127 · live from the CMS NPI Registry
Juan Faja-Fernandez, D.M.D.
Dentist, Orthodontics and Dentofacial Orthopedics in Myrtle Beach, SC. National Provider Identifier 1053754127, active.
NPI record
| NPI | 1053754127 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Orthodontics and Dentofacial Orthopedics 1223X0400X |
| Practice location | 107 Surgeons Drive, Myrtle Beach, SC 29579 |
| Practice phone | 843-206-1116 |
| Mailing address | Po Box 13799, Florence, SC 29504 |
| Enumerated | April 9, 2013 |
| Last updated | April 9, 2013 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Orthodontics and Dentofacial Orthopedics primary | 1223X0400X | 4461 (SC) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.