Provider Demographics
NPI:1750007175
Name:MORAES, FERNANDA S (DMD)
Entity type:Individual
Prefix:DR
First Name:FERNANDA
Middle Name:S
Last Name:MORAES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:FERNANDA
Other - Middle Name:S
Other - Last Name:MORAES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:725 BOSTON POST RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3387
Mailing Address - Country:US
Mailing Address - Phone:508-740-0123
Mailing Address - Fax:
Practice Address - Street 1:725 BOSTON POST RD UNIT 1
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3387
Practice Address - Country:US
Practice Address - Phone:508-740-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS51237804OtherDRIVE LICENSE