Provider Demographics
NPI:1245432343
Name:JACINTA MENEZES FERNANDES,DDS.PC
Entity Type:Organization
Organization Name:JACINTA MENEZES FERNANDES,DDS.PC
Other - Org Name:ENDODONTICS OF MALDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACINTA
Authorized Official - Middle Name:MENEZES
Authorized Official - Last Name:FERNANDES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-321-6006
Mailing Address - Street 1:10 HOLDEN ST
Mailing Address - Street 2:SECOND FLOOR, SUITE # 5
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5238
Mailing Address - Country:US
Mailing Address - Phone:781-032-1600
Mailing Address - Fax:781-324-1549
Practice Address - Street 1:10 HOLDEN ST
Practice Address - Street 2:SECOND FLOOR, SUITE # 5
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5238
Practice Address - Country:US
Practice Address - Phone:781-321-6006
Practice Address - Fax:781-324-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty