Provider Demographics
NPI:1144773664
Name:HERNANDEZ, BROOKE
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 422 BOX 549
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09067-0006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DAENNER STR. BLDG 3287
Practice Address - Street 2:
Practice Address - City:KAISERSLAUTERN
Practice Address - State:DE
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:314-590-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist