Provider Demographics
NPI:1184714248
Name:FERNANDEZ, KRIS J (DDS)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:J
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 1:7520 PERKINS RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9111
Mailing Address - Country:US
Mailing Address - Phone:225-769-1652
Mailing Address - Fax:225-769-9511
Practice Address - Street 1:7520 PERKINS RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9111
Practice Address - Country:US
Practice Address - Phone:225-769-1652
Practice Address - Fax:225-769-9511
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice