Provider Demographics
NPI:1376857441
Name:FERNANDEZ-MARTINEZ, MARIANGEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIANGEL
Middle Name:
Last Name:FERNANDEZ-MARTINEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8665 VIA ANCHO RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2227
Mailing Address - Country:US
Mailing Address - Phone:352-727-8547
Mailing Address - Fax:
Practice Address - Street 1:8903 GLADES RD STE A7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4023
Practice Address - Country:US
Practice Address - Phone:352-727-8547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-01
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN190791223G0001X
FLDN 190791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice