MEDICARE: KRIS J FERNANDEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4548	LA

General Provider Information

NPI Number	:	1184714248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRIS J FERNANDEZ DDS

Provider Business Mailing Address
First Line	:	7520 PERKINS RD
Second Line	:	SUITE 310
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-9111
Country	:	US
Telephone Number	:	225-769-1652
Fax Number	:	225-769-9511

Provider Business Practice Location Address
First Line	:	7520 PERKINS RD
Second Line	:	SUITE 310
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-9111
Country	:	US
Telephone Number	:	225-769-1652
Fax Number	:	225-769-9511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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