Provider Demographics
NPI:1093886848
Name:NARAVA, FERNANDO JOSE (DDS)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:JOSE
Last Name:NARAVA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9690 DEERECO
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21040
Mailing Address - Country:US
Mailing Address - Phone:410-560-2616
Mailing Address - Fax:410-560-0462
Practice Address - Street 1:9690 DEERECO
Practice Address - Street 2:SUITE 120
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21040
Practice Address - Country:US
Practice Address - Phone:410-560-2616
Practice Address - Fax:410-560-0462
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice