| Traci R. Fernandes, Dds, Inc | |
|
901 Oak Park Blvd Suite 203 Pismo Beach CA 93449-3216 | |
| (805) 489-8232 | |
| (805) 489-8234 |
| Full Name | Traci R. Fernandes, Dds, Inc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 901 Oak Park Blvd, Pismo Beach, California |
| Authorized Official Name and Position | Traci R. Fernandes (ORTHODONTIST) |
| Authorized Official Contact | 8054898232 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Traci R. Fernandes, Dds, Inc 901 Oak Park Blvd Suite 203 Pismo Beach CA 93449-3216 Ph: (805) 489-8232 | Traci R. Fernandes, Dds, Inc 901 Oak Park Blvd Suite 203 Pismo Beach CA 93449-3216 Ph: (805) 489-8232 |
| NPI Number | 1225042120 |
|---|---|
| Provider Enumeration Date | 07/28/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225042120 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 41830 (California) | Primary |
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