Active NPI
Noelia Maria Fernandez, DDS
- Dentist
- Detroit, MI
National Provider Identifier
1245979707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901601308
- Practice address
- 5716 Michigan Ave
Detroit, MI 48210-3039 - Phone
- (313) 554-3880
- Fax
- (313) 899-3550
- NPI assigned
- Jun 2, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901601308 | MI | Primary |
Addresses
Primary practice location
5716 Michigan Ave
Detroit, MI 48210-3039
Mailing address
559 W Grand Blvd
Detroit, MI 48216-2200
Phone (313) 554-0485
Other practice location 1
2929 Burlingame Ave SW
Wyoming, MI 49509-2600
Phone (616) 965-8333
Other practice location 2
17625 Joy Rd
Detroit, MI 48228-1999
Phone (313) 446-8800
Other practice location 3
20901 Moross Rd
Detroit, MI 48236-2058
Phone (313) 626-2620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220708000814 | MI | Order and Referring Only - Dentist | 8426438425 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901601308 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731024000000",
"number": "1245979707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "559 W GRAND BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482162200",
"telephone_number": "313-554-0485",
"fax_number": "313-228-0283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5716 MICHIGAN AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482103039",
"telephone_number": "313-554-3880",
"fax_number": "313-899-3550"
}
],
"practiceLocations": [
{
"address_1": "2929 Burlingame Ave SW",
"address_purpose": "LOCATION",
"city": "Wyoming",
"state": "MI",
"postal_code": "495092600",
"country_code": "US",
"telephone_number": "616-965-8333",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "17625 Joy Rd",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482281999",
"country_code": "US",
"telephone_number": "313-446-8800",
"fax_number": "313-228-0283",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "20901 Moross Rd",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482362058",
"country_code": "US",
"telephone_number": "313-626-2620",
"fax_number": "313-228-0283",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FERNANDEZ",
"first_name": "NOELIA",
"middle_name": "MARIA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-02",
"last_updated": "2024-11-08",
"certification_date": "2024-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901601308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.