Provider Demographics
NPI:1275701344
Name:ASCENCIO, FERNANDO (DMD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:ASCENCIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2520
Mailing Address - Country:US
Mailing Address - Phone:724-749-4842
Mailing Address - Fax:724-749-4843
Practice Address - Street 1:4065 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2520
Practice Address - Country:US
Practice Address - Phone:724-749-4842
Practice Address - Fax:724-749-4843
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-30996-L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics