Provider Demographics
NPI:1144376021
Name:HERNANDEZ, JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
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 1:2106 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2862
Mailing Address - Country:US
Mailing Address - Phone:956-318-0700
Mailing Address - Fax:956-318-0781
Practice Address - Street 1:2106 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-2862
Practice Address - Country:US
Practice Address - Phone:956-318-0700
Practice Address - Fax:956-318-0781
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB16840-01OtherCHIPS PROVIDER NUMBER
TXD16840OtherBLUE CROSS BLUE SHIELD
TX1110496-03Medicaid
TX848794OtherUNITED CONCORDIA TRICARE