Provider Demographics
NPI:1720298797
Name:FERNANDES, RICHLYN DAWNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHLYN
Middle Name:DAWNE
Last Name:FERNANDES
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:PO BOX 8486
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95208-0486
Mailing Address - Country:US
Mailing Address - Phone:209-939-9633
Mailing Address - Fax:209-939-9611
Practice Address - Street 1:4255 PACIFIC AVE
Practice Address - Street 2:STE. 6
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-7638
Practice Address - Country:US
Practice Address - Phone:209-939-9633
Practice Address - Fax:209-939-9611
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADZ0367521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice