Individual
IRENE FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E NEWTON ST, G-716, BOSTON, MA 02118-2308
(617) 638-4636
(617) 638-5322
Mailing address
2700 MARTIN LUTHER KING JR BLVD, DETROIT, MI 48208-2576
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DL12642
MA
1223E0200X
Endodontics
Primary
2952000744
MI
Other
Enumeration date
07/16/2015
Last updated
09/13/2021
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