Provider Demographics
NPI:1487385423
Name:MENDOZA CERVANTES, FERNANDA CARLA (DDS)
Entity type:Individual
Prefix:DR
First Name:FERNANDA
Middle Name:CARLA
Last Name:MENDOZA CERVANTES
Suffix:
Gender:F
Credentials:DDS
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Other - Credentials:
Mailing Address - Street 1:4545 CENTER BLVD APT 3218
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5968
Mailing Address - Country:US
Mailing Address - Phone:915-706-3503
Mailing Address - Fax:
Practice Address - Street 1:66 SOMME ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3612
Practice Address - Country:US
Practice Address - Phone:973-578-8788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0643711223P0221X
NJ22D1029853001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty