Healthcare Provider Details

I. General information

NPI: 1982353496
Provider Name (Legal Business Name): FERNANDA DANTE MARTINEZ DE FREITAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PINE CONE DR STE 1
PALM COAST FL
32164-8424
US

IV. Provider business mailing address

18 ANCHORAGE RD
FRANKLIN MA
02038-1538
US

V. Phone/Fax

Practice location:
  • Phone: 386-346-8033
  • Fax:
Mailing address:
  • Phone: 832-709-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN30464
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDL100752
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number05306
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: