MEDICARE: RENE D FERNANDO 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	122300000X	Dentist	4059	NV

General Provider Information

NPI Number	:	1821254970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE D FERNANDO DDS

Provider Business Mailing Address
First Line	:	4226 S DURANGO DR
Second Line	:	SUITE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8721
Country	:	US
Telephone Number	:	702-871-6180
Fax Number	:

Provider Business Practice Location Address
First Line	:	4226 S DURANGO DR
Second Line	:	SUITE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8721
Country	:	US
Telephone Number	:	702-871-6180
Fax Number	:

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

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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Directions to “ RENE D FERNANDO DDS” Practice Location

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