Provider Demographics
NPI:1144520248
Name:JOANNE LYNNE S. FERNANDO,D.M.D.,INC
Entity type:Organization
Organization Name:JOANNE LYNNE S. FERNANDO,D.M.D.,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE LYNNE
Authorized Official - Middle Name:SANTARINA
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-573-1086
Mailing Address - Street 1:13962 NEWPORT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7827
Mailing Address - Country:US
Mailing Address - Phone:714-573-1086
Mailing Address - Fax:714-573-8239
Practice Address - Street 1:13962 NEWPORT AVE STE C
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7827
Practice Address - Country:US
Practice Address - Phone:714-573-1086
Practice Address - Fax:714-573-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty