Provider Demographics
NPI:1639225089
Name:FERNANDES, ANTONE LARRAGAN (DDS,MS)
Entity Type:Individual
Prefix:
First Name:ANTONE
Middle Name:LARRAGAN
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 CHINO HILLS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2678
Mailing Address - Country:US
Mailing Address - Phone:909-606-7923
Mailing Address - Fax:909-597-8507
Practice Address - Street 1:4020 CHINO HILLS PKWY STE A
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-2678
Practice Address - Country:US
Practice Address - Phone:909-606-7923
Practice Address - Fax:909-597-8507
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics