Provider Demographics
NPI:1225480809
Name:HERNANDEZ, EMILIO ROBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:ROBERTO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FOUNDRY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-9914
Mailing Address - Country:US
Mailing Address - Phone:603-333-2538
Mailing Address - Fax:
Practice Address - Street 1:16 FOUNDRY ST STE 202
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-9914
Practice Address - Country:US
Practice Address - Phone:603-333-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2643122300000X
NH048181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist