Provider Demographics
NPI:1417383092
Name:FERNANDEZ-FEO, CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:FERNANDEZ-FEO
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 1:8115 NW 53RD ST APT 218
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4775
Mailing Address - Country:US
Mailing Address - Phone:786-537-6819
Mailing Address - Fax:
Practice Address - Street 1:10830 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2854
Practice Address - Country:US
Practice Address - Phone:786-845-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN203831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics