Provider Demographics
NPI:1730938341
Name:FAJARDIN, RENEE (DDS)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:FAJARDIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13275 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3984
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:
Practice Address - Street 1:110 S WOODLAND ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3546
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN29684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program