Provider Demographics
NPI:1033524285
Name:DR ANTONIO HERNANDEZ LLC
Entity Type:Organization
Organization Name:DR ANTONIO HERNANDEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-779-4049
Mailing Address - Street 1:CALLE 6 URB LA MILAGROSA
Mailing Address - Street 2:CENTRO COMERCIAL LA MILAGROSA OF5
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-779-4049
Mailing Address - Fax:787-785-7125
Practice Address - Street 1:F19 CALLE ISLA NENA
Practice Address - Street 2:REPARTO FLAMINGO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-4936
Practice Address - Country:US
Practice Address - Phone:787-779-4049
Practice Address - Fax:787-785-7125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty