Provider Demographics
NPI:1174651210
Name:FERNANDES, RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:RENEE
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 1:172 KAYDEROSS PARK RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8704
Mailing Address - Country:US
Mailing Address - Phone:917-399-5474
Mailing Address - Fax:
Practice Address - Street 1:520 W STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4045
Practice Address - Country:US
Practice Address - Phone:407-862-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052839-1122300000X
FLDN17802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist