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General NPI Number Information
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NPI Number | 1487385423
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Entity Type | Individual
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Provider Name | FERNANDA CARLA MENDOZA CERVANTES DDS
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Gender | Female
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 03/22/2025
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Provider Practice Location Address
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Address Line | 66 SOMME ST
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City | NEWARK
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State | NJ
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Zip | 07105-3612
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Country | US
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Telephone | 973-578-8788
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Fax |
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Provider Business Mailing Address
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Address Line | 4545 CENTER BLVD APT 3218
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City | LONG ISLAND CITY
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State | NY
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Zip | 11109-5968
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Country | US
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Telephone | 915-706-3503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 064371
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22D102985300
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License Number State | NJ
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