Provider Demographics
NPI:1720209596
Name:FERNANDES-MORAIS, MARIA NIVEDITA JOUVITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:NIVEDITA JOUVITA
Last Name:FERNANDES-MORAIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 HILL VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6589
Mailing Address - Country:US
Mailing Address - Phone:817-681-7680
Mailing Address - Fax:
Practice Address - Street 1:2900 HILL VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-6589
Practice Address - Country:US
Practice Address - Phone:817-681-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1645590-03Medicaid
TX1645590-01Medicaid
TX1645590-02Medicaid