Individual
JUAN FAJA-FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
107 SURGEONS DRIVE, MYRTLE BEACH, SC 29579
(843) 206-1116
Mailing address
PO BOX 13799, FLORENCE, SC 29504-3799
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4461
SC
Other
Enumeration date
04/09/2013
Last updated
04/09/2013
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