Provider Demographics
NPI:1730390998
Name:MIGUEL FERNANDEZ DDS, LTD
Entity type:Organization
Organization Name:MIGUEL FERNANDEZ DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:747-497-4825
Mailing Address - Street 1:520 S INDEPENDENCE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1152
Mailing Address - Country:US
Mailing Address - Phone:757-497-4825
Mailing Address - Fax:757-497-1206
Practice Address - Street 1:520 S INDEPENDENCE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1152
Practice Address - Country:US
Practice Address - Phone:757-497-4825
Practice Address - Fax:757-497-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty