Healthcare Provider Details

I. General information

NPI: 1205114162
Provider Name (Legal Business Name): THOMAS LOWELL FERNANDES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N SPOKANE ST
POST FALLS ID
83854-9513
US

IV. Provider business mailing address

313 N SPOKANE ST
POST FALLS ID
83854-9513
US

V. Phone/Fax

Practice location:
  • Phone: 208-773-4579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60802224
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD4886
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: