Provider Demographics
NPI:1073703765
Name:HERNANDEZ, PEDRO LUIS (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:LUIS
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CALLE BARNARD
Mailing Address - Street 2:RPTO UNIVERSITARIO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1836
Mailing Address - Country:US
Mailing Address - Phone:787-760-3676
Mailing Address - Fax:
Practice Address - Street 1:CARR 181 KM 3.4
Practice Address - Street 2:PLAZA TRUJILLO STE 20
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-760-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist