Provider Demographics
NPI:1962135814
Name:FERNANDEZ, YISSEL (DMD)
Entity type:Individual
Prefix:DR
First Name:YISSEL
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10540 NW 10TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3907
Mailing Address - Country:US
Mailing Address - Phone:786-655-1615
Mailing Address - Fax:
Practice Address - Street 1:8740 N KENDALL DR STE 214
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2221
Practice Address - Country:US
Practice Address - Phone:305-740-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN272641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice