MEDICARE: CRISTIAN J FERNANDEZ DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1932821550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRISTIAN J FERNANDEZ DDS INC

Provider Business Mailing Address
First Line	:	803 COFFEE RD STE B
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-4227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 S R VALLEY BLVD STE 205
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1523
Country	:	US
Telephone Number	:	209-521-5486
Fax Number	:

Authorized Official
Title or Position	:	CEO/PROVIDER
Name	:	CRISTIAN FERNANDEZ
Credential	:	DDS
Telephone Number	:	209-521-5486

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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