Provider Demographics
NPI:1932657574
Name:FERNANDEZ, LORIE (RDH)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6031
Mailing Address - Country:US
Mailing Address - Phone:520-770-2700
Mailing Address - Fax:
Practice Address - Street 1:1500 W COMMERCE CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6031
Practice Address - Country:US
Practice Address - Phone:520-770-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH007472124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist