Sonia Rivero Fernandez, DMD
Individual provider Active NPI Dentist · Lady Lake, FL
NPI 1780179119 · NPPES record last updated Jun 27, 2018
Key facts
- NPI
- 1780179119
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN23544 (FL)
- Practice address
- 870 N US Highway 27 Ste a
Lady Lake, FL 32159-3108 - Phone
- (352) 282-4785
- NPI assigned
- Jun 27, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181030001486 | FL | Order and Referring Only - Dentist |
3971856410 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lady Lake Smiles Dentistry, PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN23544 | FL | Yes |
Addresses
Primary practice location
870 N US Highway 27 Ste a
Lady Lake, FL 32159-3108
Mailing address
39931 Parkinsonia St
Lady Lake, FL 32159-3458
Phone (813) 405-7935
Other providers in Lady Lake, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.