Provider Demographics
NPI:1306841663
Name:PADILLA-NAZARIO, FERNANDO MANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:MANUEL
Last Name:PADILLA-NAZARIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:FERNANDO
Other - Middle Name:M
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:19 CALLE ACUARIO
Mailing Address - Street 2:STE 5
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4902
Mailing Address - Country:US
Mailing Address - Phone:787-755-3690
Mailing Address - Fax:787-755-3132
Practice Address - Street 1:19 CALLE ACUARIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4902
Practice Address - Country:US
Practice Address - Phone:787-755-3690
Practice Address - Fax:787-755-3132
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice