Provider Demographics
NPI:1215268768
Name:FERNANDEZ, VANESSA M (DMD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:M
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:M
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PASEO SAN JUAN
Mailing Address - Street 2:CATEDRAL #D-3
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-748-9369
Mailing Address - Fax:
Practice Address - Street 1:PASEO SAN JUAN
Practice Address - Street 2:CATEDRAL #D-3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-748-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist