Provider Demographics
NPI:1497001564
Name:NEIRA, FERNANDO A (DDS)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:A
Last Name:NEIRA
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 1:12503 SW 94TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1889
Mailing Address - Country:US
Mailing Address - Phone:786-380-0131
Mailing Address - Fax:
Practice Address - Street 1:9330 BEN C PRATT/6 MILE CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-6505
Practice Address - Country:US
Practice Address - Phone:239-337-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN198911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice