Provider Demographics
NPI:1275611600
Name:FERNANDEZ, DELIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DELIA
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:P.O. BOX 232
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474
Mailing Address - Country:US
Mailing Address - Phone:931-379-7711
Mailing Address - Fax:931-379-7729
Practice Address - Street 1:703 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474
Practice Address - Country:US
Practice Address - Phone:931-379-7711
Practice Address - Fax:931-379-7729
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81361223G0001X
TNDS81361223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice