Samuel Tamayo Fernandez Jr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D012283 Issued in AZ

Practice address

2805 W Agua Fria Fwy Ste 8a
Phoenix, AZ 85027-3901

Phone

(623) 255-3390

NPI assigned

Aug 21, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Sam Tamayo Fernandez Jr. Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Deer Valley Dental Group, LLP

  • Dentist
  • Phoenix, AZ
  • NPI 1053766287
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1043043565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7900 E PRINCESS DR APT 2249",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852555867",
            "telephone_number": "224-436-2570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 W AGUA FRIA FWY STE 8A",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273901",
            "telephone_number": "623-255-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "SAMUEL",
        "middle_name": "TAMAYO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-21",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D012283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAM",
            "last_name": "FERNANDEZ",
            "middle_name": "TAMAYO",
            "prefix": "DR.",
            "suffix": "JR.",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mia G Fernandez, RBT
• Monica Fernandez
• Nayda Fernandez, RN
• Robin Renae Fernandez, M.ED, LISAC
• Rosa Ileana Fernandez
• Barry Fernando, MD
• Coleene Fernando, MD
• Norman M Fernando, MD
• Shahan Fernando, M.D.
• Limy Fernandus, FNP-C

• Dentist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.