Provider Demographics
NPI:1891558797
Name:KYLENE H FERNANDEZ DDS MS LLC
Entity Type:Organization
Organization Name:KYLENE H FERNANDEZ DDS MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:614-527-1000
Mailing Address - Street 1:3663 RIDGE MILL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7799
Mailing Address - Country:US
Mailing Address - Phone:614-527-1000
Mailing Address - Fax:614-527-0100
Practice Address - Street 1:3663 RIDGE MILL DR STE 102
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7799
Practice Address - Country:US
Practice Address - Phone:614-527-1000
Practice Address - Fax:614-527-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty