Provider Demographics
NPI:1063451573
Name:FERNANDEZ, FREDERICK (DMD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9368
Mailing Address - Street 2:PLAZA CAROLINA STATION
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9368
Mailing Address - Country:US
Mailing Address - Phone:787-768-2929
Mailing Address - Fax:787-768-2929
Practice Address - Street 1:VIA JOSEFINA 4-SS-8
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-768-2929
Practice Address - Fax:787-268-2929
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist