Provider Demographics
NPI:1992997050
Name:FERNEINI, ELIE M (DMD, MD, MHS, MBA)
Entity type:Individual
Prefix:DR
First Name:ELIE
Middle Name:M
Last Name:FERNEINI
Suffix:
Gender:M
Credentials:DMD, MD, MHS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 HIGHLAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2583
Mailing Address - Country:US
Mailing Address - Phone:203-272-7700
Mailing Address - Fax:203-651-0046
Practice Address - Street 1:435 HIGHLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2583
Practice Address - Country:US
Practice Address - Phone:203-272-7700
Practice Address - Fax:203-651-0046
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT91671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery