MEDICARE: DR. FERNANDO A NEIRA 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	DN19891	FL

General Provider Information

NPI Number	:	1497001564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO A NEIRA DDS

Provider Business Mailing Address
First Line	:	12503 SW 94TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1889
Country	:	US
Telephone Number	:	786-380-0131
Fax Number	:

Provider Business Practice Location Address
First Line	:	9330 BEN C PRATT/6 MILE CYPRESS PKWY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6505
Country	:	US
Telephone Number	:	239-337-1008
Fax Number	:

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

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	07/26/2012

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