Provider Demographics
NPI:1104016971
Name:HERNANDO SUAREZ DDS,INC
Entity Type:Organization
Organization Name:HERNANDO SUAREZ DDS,INC
Other - Org Name:MARANATHA DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-537-7773
Mailing Address - Street 1:13252 CENTURY BLVD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1256
Mailing Address - Country:US
Mailing Address - Phone:714-537-7773
Mailing Address - Fax:714-537-7755
Practice Address - Street 1:17157 SPRING CANYON PL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-0234
Practice Address - Country:US
Practice Address - Phone:951-353-2873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty