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General NPI Number Information
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NPI Number | 1720298797
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Entity Type | Individual
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Provider Name | RICHLYN DAWNE FERNANDES DDS
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 4255 PACIFIC AVE STE. 6
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City | STOCKTON
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State | CA
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Zip | 95207-7638
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Country | US
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Telephone | 209-939-9633
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Fax | 209-939-9611
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Provider Business Mailing Address
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Address Line | PO BOX 8486
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City | STOCKTON
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State | CA
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Zip | 95208-0486
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Country | US
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Telephone | 209-939-9633
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Fax | 209-939-9611
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DZ036752
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License Number State | CA
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