Provider Demographics
NPI:1609761386
Name:CHIRIVELLA, MARIA FERNANDA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:FERNANDA
Last Name:CHIRIVELLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DOCTORS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4900
Mailing Address - Country:US
Mailing Address - Phone:863-676-8536
Mailing Address - Fax:
Practice Address - Street 1:1 DOCTORS LN
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4900
Practice Address - Country:US
Practice Address - Phone:863-676-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist