Healthcare Provider Details

I. General information

NPI: 1255259560
Provider Name (Legal Business Name): FERNANDA CRISTINA BITTENCOURT LIBANORE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 QUEEN ANNE CT
SANDY SPRINGS GA
30350-6303
US

IV. Provider business mailing address

2906 QUEEN ANNE CT
SANDY SPRINGS GA
30350-6303
US

V. Phone/Fax

Practice location:
  • Phone: 983-210-0228
  • Fax:
Mailing address:
  • Phone: 983-210-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberRESIDENT
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: