Provider Demographics
NPI:1447409339
Name:FERNANDEZ, CARMEN ARACELY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ARACELY
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 SOUTH RAINBOW BLVD
Mailing Address - Street 2:STE. 202
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0855
Mailing Address - Country:US
Mailing Address - Phone:702-889-1880
Mailing Address - Fax:702-256-7912
Practice Address - Street 1:1811 SOUTH RAINBOW BLVD
Practice Address - Street 2:STE. 202
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0855
Practice Address - Country:US
Practice Address - Phone:702-889-1880
Practice Address - Fax:702-256-7912
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS7-271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics