MEDICARE: DR. DELIA 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	8136	TN
2	1223D0001X	Public Health Dentistry	DS8136	TN

General Provider Information

NPI Number	:	1275611600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELIA FERNANDEZ DDS

Provider Business Mailing Address
First Line	:	P.O. BOX 232
Second Line	:
City	:	MT. PLEASANT
State	:	TN
Zip	:	38474
Country	:	US
Telephone Number	:	931-379-7711
Fax Number	:	931-379-7729

Provider Business Practice Location Address
First Line	:	703 N. MAIN ST.
Second Line	:
City	:	MT. PLEASANT
State	:	TN
Zip	:	38474
Country	:	US
Telephone Number	:	931-379-7711
Fax Number	:	931-379-7729

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	02/12/2016

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