Provider Demographics
NPI:1083747570
Name:HERNANDEZ, RONALDO GABRIEL (DDS)
Entity Type:Individual
Prefix:
First Name:RONALDO
Middle Name:GABRIEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RON
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2211 PARKSIDE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5358
Mailing Address - Country:US
Mailing Address - Phone:510-792-1100
Mailing Address - Fax:510-792-8043
Practice Address - Street 1:2211 PARKSIDE DR
Practice Address - Street 2:SUITE D
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5358
Practice Address - Country:US
Practice Address - Phone:510-792-1100
Practice Address - Fax:510-792-8043
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice