Provider Demographics
NPI:1942762364
Name:FERNANDEZ CARDOSO, ALIEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIEN
Middle Name:
Last Name:FERNANDEZ CARDOSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14562 SW 142ND COURT CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5627
Mailing Address - Country:US
Mailing Address - Phone:786-759-6767
Mailing Address - Fax:
Practice Address - Street 1:9280 HAMMOCKS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1594
Practice Address - Country:US
Practice Address - Phone:305-387-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26217122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program