Provider Demographics
NPI:1770809030
Name:FERNANDEZ, ERGINIO (DMD)
Entity type:Individual
Prefix:DR
First Name:ERGINIO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1710
Mailing Address - Country:US
Mailing Address - Phone:973-985-0762
Mailing Address - Fax:
Practice Address - Street 1:714 RTE 10
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2058
Practice Address - Country:US
Practice Address - Phone:973-366-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02411000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist