Provider Demographics
NPI:1356087084
Name:J HERNANDEZ DDS INC
Entity Type:Organization
Organization Name:J HERNANDEZ DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-719-1199
Mailing Address - Street 1:27365 JEFFERSON AVE STE L-M
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5692
Mailing Address - Country:US
Mailing Address - Phone:951-719-1199
Mailing Address - Fax:
Practice Address - Street 1:27365 JEFFERSON AVE STE L-M
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5692
Practice Address - Country:US
Practice Address - Phone:951-719-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty