Provider Demographics
NPI:1013111780
Name:FERNANDEZ, ARIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26131 CAMELOT AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4131
Mailing Address - Country:US
Mailing Address - Phone:951-652-4040
Mailing Address - Fax:951-652-4051
Practice Address - Street 1:810 SAINT JOHN PL
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4414
Practice Address - Country:US
Practice Address - Phone:951-652-4040
Practice Address - Fax:951-652-4051
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice