Provider Demographics
NPI:1184646390
Name:FERNANDEZ, MIGUEL EDUARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:EDUARDO
Last Name:FERNANDEZ
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 1:520 S INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1152
Mailing Address - Country:US
Mailing Address - Phone:757-497-4825
Mailing Address - Fax:757-497-1206
Practice Address - Street 1:520 S INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1152
Practice Address - Country:US
Practice Address - Phone:757-497-4825
Practice Address - Fax:757-497-1206
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014102831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice