Active NPI
Richlyn Dawne Fernandes, DDS
- General Practice Dentistry
- Stockton, CA
National Provider Identifier
1720298797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DZ036752
- Practice address
- 4255 Pacific Ave
Ste. 6
Stockton, CA 95207-7638 - Phone
- (209) 939-9633
- Fax
- (209) 939-9611
- NPI assigned
- May 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DZ036752 | CA | Primary |
Addresses
Primary practice location
4255 Pacific Ave
Ste. 6
Stockton, CA 95207-7638
Mailing address
PO Box 8486
Stockton, CA 95208-0486
Phone (209) 939-9633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- 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 |
|---|---|---|---|---|
| I20130904000197 | CA | Practitioner - Oral Surgery | 3870736226 | Practice locations: Stockton, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372291200000",
"number": "1720298797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8486",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952080486",
"telephone_number": "209-939-9633",
"fax_number": "209-939-9611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4255 PACIFIC AVE",
"address_2": "STE. 6",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952077638",
"telephone_number": "209-939-9633",
"fax_number": "209-939-9611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDES",
"first_name": "RICHLYN",
"middle_name": "DAWNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2013-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "DZ036752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; 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.