Provider Demographics
NPI:1295833978
Name:HERNANDEZ, DINO CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DINO
Middle Name:CARLOS
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DINO
Other - Middle Name:CARLOS
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1014 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4139
Mailing Address - Country:US
Mailing Address - Phone:323-725-9999
Mailing Address - Fax:
Practice Address - Street 1:1014 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4139
Practice Address - Country:US
Practice Address - Phone:323-725-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice