MEDICARE: MICHELLE 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	10555	TN

General Provider Information

NPI Number	:	1619321122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE FERNANDEZ DDS

Provider Business Mailing Address
First Line	:	300 11TH AVE N APT 314
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-3644
Country	:	US
Telephone Number	:	615-554-4482
Fax Number	:

Provider Business Practice Location Address
First Line	:	2153 GALLATIN PIKE N
Second Line	:
City	:	MADISON
State	:	TN
Zip	:	37115
Country	:	US
Telephone Number	:	615-933-0227
Fax Number	:

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

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	12/27/2018

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