Provider Demographics
NPI:1104440197
Name:FERNANDES, JOSEPH HERMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HERMAN
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 ALLISON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2418
Mailing Address - Country:US
Mailing Address - Phone:703-973-0660
Mailing Address - Fax:
Practice Address - Street 1:1124 ALLISON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2418
Practice Address - Country:US
Practice Address - Phone:703-973-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN266951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice