Provider Demographics
NPI:1104946490
Name:FERNANDEZ, DEMETRIO DELA ROSA JR (DMD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIO
Middle Name:DELA ROSA
Last Name:FERNANDEZ
Suffix:JR
Gender:M
Credentials:DMD
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Mailing Address - Street 1:25982 PALA DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-829-8411
Mailing Address - Fax:949-829-8650
Practice Address - Street 1:25982 PALA DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-829-8411
Practice Address - Fax:949-829-8650
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA386781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice