Healthcare Provider Details

I. General information

NPI: 1730390998
Provider Name (Legal Business Name): MIGUEL FERNANDEZ DDS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 03/14/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S INDEPENDENCE BLVD STE 102
VIRGINIA BEACH VA
23452-1152
US

IV. Provider business mailing address

520 S INDEPENDENCE BLVD STE 102
VIRGINIA BEACH VA
23452-1152
US

V. Phone/Fax

Practice location:
  • Phone: 757-497-4825
  • Fax: 757-497-1206
Mailing address:
  • Phone: 757-497-4825
  • Fax: 757-497-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MIGUEL EDUARDO FERNANDEZ
Title or Position: PRESIDENT
Credential: DDS
Phone: 747-497-4825