Provider Demographics
NPI:1043873060
Name:J.W HERNANDEZ JR. DDS PC
Entity Type:Organization
Organization Name:J.W HERNANDEZ JR. DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-533-8191
Mailing Address - Street 1:1347 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-1437
Mailing Address - Country:US
Mailing Address - Phone:210-533-8191
Mailing Address - Fax:210-533-5928
Practice Address - Street 1:1347 FAIR AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1437
Practice Address - Country:US
Practice Address - Phone:210-533-8191
Practice Address - Fax:210-533-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty