Provider Demographics
NPI:1336138429
Name:HERNANDEZ, LUZ JANETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:JANETH
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27650 CASHFORD CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6957
Mailing Address - Country:US
Mailing Address - Phone:813-903-8888
Mailing Address - Fax:877-797-4054
Practice Address - Street 1:27650 CASHFORD CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6957
Practice Address - Country:US
Practice Address - Phone:813-903-8888
Practice Address - Fax:877-797-4054
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL176771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02681487Medicaid