Provider Demographics
NPI:1649251208
Name:FERNANDES, ROHINI (DDS)
Entity type:Individual
Prefix:DR
First Name:ROHINI
Middle Name:
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 NORTHFIELD AVE
Mailing Address - Street 2:SUITE LL4
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3026
Mailing Address - Country:US
Mailing Address - Phone:973-325-5030
Mailing Address - Fax:
Practice Address - Street 1:405 NORTHFIELD AVE
Practice Address - Street 2:SUITE LL4
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3026
Practice Address - Country:US
Practice Address - Phone:973-325-5030
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI19713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist