Individual
CECILIA MARIE FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
30 ELIZABETH ST STE 2, DERBY, CT 06418-1802
(203) 736-5460
(203) 736-5462
Mailing address
400 COLUMBUS AVE, CREDENTIALING SPECIALIST, NEW HAVEN, CT 06519-1233
(203) 503-3174
(203) 503-3174
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
8467
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235900
—
CT
Enumeration date
04/17/2017
Last updated
04/17/2017
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