Provider Demographics
NPI:1407999139
Name:FERNANDEZ, JAIME JOSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:JOSE
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4335
Mailing Address - Country:US
Mailing Address - Phone:516-827-1989
Mailing Address - Fax:516-827-1989
Practice Address - Street 1:458 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1825
Practice Address - Country:US
Practice Address - Phone:631-423-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0450941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice