1245432343 NPI number — JACINTA MENEZES FERNANDES,DDS.PC

Table of content: (NPI 1245432343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245432343 NPI number — JACINTA MENEZES FERNANDES,DDS.PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACINTA MENEZES FERNANDES,DDS.PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245432343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 HOLDEN ST
Provider Second Line Business Mailing Address:
SECOND FLOOR, SUITE # 5
Provider Business Mailing Address City Name:
MALDEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02148-5238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-032-1600
Provider Business Mailing Address Fax Number:
781-324-1549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 HOLDEN ST
Provider Second Line Business Practice Location Address:
SECOND FLOOR, SUITE # 5
Provider Business Practice Location Address City Name:
MALDEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02148-5238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-321-6006
Provider Business Practice Location Address Fax Number:
781-324-1549
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDES
Authorized Official First Name:
JACINTA
Authorized Official Middle Name:
MENEZES
Authorized Official Title or Position:
ENDODONTIST
Authorized Official Telephone Number:
781-321-6006

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  18968 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com