Provider Demographics
NPI:1093488330
Name:FERNANDEZ CABADA, YORDANSKA (DMD)
Entity Type:Individual
Prefix:
First Name:YORDANSKA
Middle Name:
Last Name:FERNANDEZ CABADA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 HALF MOON CT
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5569
Mailing Address - Country:US
Mailing Address - Phone:430-280-5635
Mailing Address - Fax:
Practice Address - Street 1:2494 AIRLINE DR STE 100
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5841
Practice Address - Country:US
Practice Address - Phone:318-317-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376901223G0001X
LA73721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice