Provider Demographics
NPI:1710128319
Name:FERNANDEZ FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:FERNANDEZ FAMILY DENTAL CENTER
Other - Org Name:FAMILY SMILE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-557-1448
Mailing Address - Street 1:3148 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3886
Mailing Address - Country:US
Mailing Address - Phone:305-557-1448
Mailing Address - Fax:305-557-1975
Practice Address - Street 1:3148 W 76TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-3886
Practice Address - Country:US
Practice Address - Phone:305-557-1448
Practice Address - Fax:305-557-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty