Provider Demographics
NPI:1598974248
Name:FERNANDEZ, JUNIOR J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUNIOR
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 SW 106TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7942
Mailing Address - Country:US
Mailing Address - Phone:305-807-8827
Mailing Address - Fax:305-223-6935
Practice Address - Street 1:4901 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5105
Practice Address - Country:US
Practice Address - Phone:305-446-8115
Practice Address - Fax:305-446-5023
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 17590OtherDENTAL LICENSE NUMBER