Provider Demographics
NPI:1467548099
Name:FERNANDEZ, KYLENE H (DDS)
Entity Type:Individual
Prefix:
First Name:KYLENE
Middle Name:H
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 1:3663 RIDGE MILL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7799
Mailing Address - Country:US
Mailing Address - Phone:614-527-1000
Mailing Address - Fax:614-527-0100
Practice Address - Street 1:3663 RIDGE MILL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7799
Practice Address - Country:US
Practice Address - Phone:614-527-1000
Practice Address - Fax:614-527-1000
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300194291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2052040Medicaid