Provider Demographics
NPI:1710302385
Name:FERNANDEZ DENTAL OFFICE KENDALL
Entity Type:Organization
Organization Name:FERNANDEZ DENTAL OFFICE KENDALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-598-7550
Mailing Address - Street 1:8740 N KENDALL DR STE 214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2221
Mailing Address - Country:US
Mailing Address - Phone:305-598-7550
Mailing Address - Fax:
Practice Address - Street 1:8740 N KENDALL DR STE 214
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2221
Practice Address - Country:US
Practice Address - Phone:305-598-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty