Provider Demographics
NPI:1992896690
Name:FERNANDEZ, MICHAEL J (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7895 SEMINOLE BOULEVARD STE 202
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777
Mailing Address - Country:US
Mailing Address - Phone:727-397-6673
Mailing Address - Fax:727-393-3884
Practice Address - Street 1:9009 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-4152
Practice Address - Country:US
Practice Address - Phone:727-397-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist