Provider Demographics
NPI:1053419515
Name:FERNANDEZ, NOEL AUSTRIA (DMD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:AUSTRIA
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-5712
Mailing Address - Country:US
Mailing Address - Phone:707-674-2777
Mailing Address - Fax:707-642-2890
Practice Address - Street 1:2629 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-5712
Practice Address - Country:US
Practice Address - Phone:707-674-2777
Practice Address - Fax:707-642-2890
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92995-01Medicare ID - Type UnspecifiedMEDICAL ID NUMBER