Provider Demographics
NPI:1245877521
Name:FERNANDES, ADAM ANDREW (DDS, DOCTOR OF DENTA)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ANDREW
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:DDS, DOCTOR OF DENTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WEST 57TH STREET
Mailing Address - Street 2:APARTMENT 7A
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:718-902-8302
Mailing Address - Fax:
Practice Address - Street 1:9-25 ALLING STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-297-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2021-09-14
Deactivation Date:2020-12-08
Deactivation Code:
Reactivation Date:2021-09-14
Provider Licenses
StateLicense IDTaxonomies
NJ2201028516001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice