Provider Demographics
NPI:1043043565
Name:FERNANDEZ, SAMUEL TAMAYO JR (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:TAMAYO
Last Name:FERNANDEZ
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:TAMAYO
Other - Last Name:FERNANDEZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7900 E PRINCESS DR APT 2249
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5867
Mailing Address - Country:US
Mailing Address - Phone:224-436-2570
Mailing Address - Fax:
Practice Address - Street 1:2805 W AGUA FRIA FWY STE 8A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3901
Practice Address - Country:US
Practice Address - Phone:623-255-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist