Provider Demographics
NPI:1770052854
Name:MORAIS, FERNANDA SCANDELARI (DMD)
Entity type:Individual
Prefix:DR
First Name:FERNANDA
Middle Name:SCANDELARI
Last Name:MORAIS
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 1:906 N DOHENY DR APT 505
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3163
Mailing Address - Country:US
Mailing Address - Phone:973-462-0648
Mailing Address - Fax:
Practice Address - Street 1:140 N VICTORY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1848
Practice Address - Country:US
Practice Address - Phone:323-773-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-18
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061038122300000X
CA106940122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist