Healthcare Provider Details

I. General information

NPI: 1528073251
Provider Name (Legal Business Name): GAIL P FERNANDO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 HANCOCK ST
NORTH QUINCY MA
02171-2438
US

IV. Provider business mailing address

339 HANCOCK ST
NORTH QUINCY MA
02171-2438
US

V. Phone/Fax

Practice location:
  • Phone: 617-328-4600
  • Fax:
Mailing address:
  • Phone: 617-328-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20295
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: