Organization
IVETTE M FERNANDEZ DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVETTE M FERNANDEZ DMD (PRESIDENT)
(941) 639-1124
Entity
Organization
Contact information
Practice address
502 E OLYMPIA AVE, PUNTA GORDA, FL 33950-3838
(941) 639-1124
Mailing address
502 E OLYMPIA AVE, PUNTA GORDA, FL 33950-3838
(941) 639-1124
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN15145
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070543800
—
FL
Enumeration date
08/08/2006
Last updated
06/08/2016
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