Provider Demographics
NPI:1609880145
Name:FERNANDEZ, AURELIO JOSE (DMD)
Entity Type:Individual
Prefix:
First Name:AURELIO
Middle Name:JOSE
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 1:9299 SW 152ND ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1775
Mailing Address - Country:US
Mailing Address - Phone:305-235-8912
Mailing Address - Fax:305-235-8916
Practice Address - Street 1:9299 SW 152ND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1775
Practice Address - Country:US
Practice Address - Phone:305-235-8912
Practice Address - Fax:305-235-8916
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN139311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice