Healthcare Provider Details

I. General information

NPI: 1013604057
Provider Name (Legal Business Name): ARMANDO FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N PRESTON RD STE 20
PROSPER TX
75078-9291
US

IV. Provider business mailing address

1235 VZ COUNTY ROAD 3425
WILLS POINT TX
75169-9464
US

V. Phone/Fax

Practice location:
  • Phone: 972-426-8770
  • Fax:
Mailing address:
  • Phone: 903-288-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42508
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: