Provider Demographics
NPI:1053944454
Name:FERNANDEZ-RIERA, YESENIA (DMD)
Entity type:Individual
Prefix:DR
First Name:YESENIA
Middle Name:
Last Name:FERNANDEZ-RIERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7867 NW 193RD TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6348
Mailing Address - Country:US
Mailing Address - Phone:305-331-9464
Mailing Address - Fax:
Practice Address - Street 1:160 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5264
Practice Address - Country:US
Practice Address - Phone:561-276-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24622122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentistGroup - Single Specialty