Provider Demographics
NPI:1114022068
Name:HERNANDEZ, HERIBERTO A (DDS)
Entity Type:Individual
Prefix:DR
First Name:HERIBERTO
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 NORTH FWY
Mailing Address - Street 2:F-350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-3604
Mailing Address - Country:US
Mailing Address - Phone:832-462-9115
Mailing Address - Fax:
Practice Address - Street 1:4400 NORTH FWY
Practice Address - Street 2:F-350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3604
Practice Address - Country:US
Practice Address - Phone:832-462-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics