Provider Demographics
NPI:1093920902
Name:FERNANDEZ, CONCEPCION (DDS)
Entity Type:Individual
Prefix:MS
First Name:CONCEPCION
Middle Name:
Last Name:FERNANDEZ
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 1:9724 SW 40 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165
Mailing Address - Country:US
Mailing Address - Phone:305-221-3666
Mailing Address - Fax:305-675-0267
Practice Address - Street 1:9724 SW 40 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165
Practice Address - Country:US
Practice Address - Phone:305-221-3666
Practice Address - Fax:305-675-0267
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0132411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice