MEDICARE: KYLENE H 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	1223P0221X	Pediatric Dentistry	30019429	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467548099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLENE H FERNANDEZ DDS

Provider Business Mailing Address
First Line	:	3663 RIDGE MILL DR
Second Line	:	SUITE 102
City	:	HILLIARD
State	:	OH
Zip	:	43026-7799
Country	:	US
Telephone Number	:	614-527-1000
Fax Number	:	614-527-0100

Provider Business Practice Location Address
First Line	:	3663 RIDGE MILL DR
Second Line	:	SUITE 102
City	:	HILLIARD
State	:	OH
Zip	:	43026-7799
Country	:	US
Telephone Number	:	614-527-1000
Fax Number	:	614-527-1000

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/09/2007

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