Provider Demographics
NPI:1649675802
Name:FERNANDEZ, OLIVER (DMD)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1313
Mailing Address - Country:US
Mailing Address - Phone:415-777-3337
Mailing Address - Fax:415-777-3338
Practice Address - Street 1:683 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1313
Practice Address - Country:US
Practice Address - Phone:415-777-3337
Practice Address - Fax:415-777-3338
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist