Healthcare Provider Details

I. General information

NPI: 1174221972
Provider Name (Legal Business Name): RODRIGO S FERNANDES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 E STATE ROAD 434 STE 1020
WINTER SPRINGS FL
32708-2723
US

IV. Provider business mailing address

1122 E STATE ROAD 434 STE 1020
WINTER SPRINGS FL
32708-2723
US

V. Phone/Fax

Practice location:
  • Phone: 689-201-6327
  • Fax:
Mailing address:
  • Phone: 689-201-6327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: