Provider Demographics
NPI:1881751972
Name:FERNANDES, JACINTA M (DDS)
Entity type:Individual
Prefix:DR
First Name:JACINTA
Middle Name:M
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 1:10 HOLDEN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5238
Mailing Address - Country:US
Mailing Address - Phone:781-321-6006
Mailing Address - Fax:
Practice Address - Street 1:10 HOLDEN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5238
Practice Address - Country:US
Practice Address - Phone:781-321-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics