Provider Demographics
NPI:1326055575
Name:FERNANDEZ, HOWARD P (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:P
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 FALESCO LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1627
Mailing Address - Country:US
Mailing Address - Phone:980-245-7334
Mailing Address - Fax:980-245-7334
Practice Address - Street 1:348 FALESCO LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1627
Practice Address - Country:US
Practice Address - Phone:980-245-7334
Practice Address - Fax:980-245-7334
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903366Medicaid