Provider Demographics
NPI:1275625824
Name:HERNANDEZ, PEDRO J SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:J
Last Name:HERNANDEZ
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PEDRO
Other - Middle Name:J
Other - Last Name:HERNANDEZ
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:HERNANDEZ DENTAL OFFICE
Mailing Address - Street 2:491 21 AVENUE FIRST FLOORS
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07513-1656
Mailing Address - Country:US
Mailing Address - Phone:973-247-9700
Mailing Address - Fax:973-247-9781
Practice Address - Street 1:491 21 AVENUE FIRST FLOORS
Practice Address - Street 2:SUITE # 2
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07513-1656
Practice Address - Country:US
Practice Address - Phone:973-247-9700
Practice Address - Fax:973-247-9781
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1020374001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8393206Medicaid