Provider Demographics
NPI:1730118605
Name:FERNANDEZ, ALFREDO JOSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
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 1:6199 WINDING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3779
Mailing Address - Country:US
Mailing Address - Phone:561-422-6577
Mailing Address - Fax:561-422-8595
Practice Address - Street 1:3911 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3902
Practice Address - Country:US
Practice Address - Phone:561-498-0050
Practice Address - Fax:561-498-0841
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL128941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics