Provider Demographics
NPI:1407418700
Name:HERNANDEZ, JESUS EFRAIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:EFRAIN
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 1:1586 ASCHINGER BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-4613
Mailing Address - Country:US
Mailing Address - Phone:863-257-6367
Mailing Address - Fax:
Practice Address - Street 1:1882 HARD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1996
Practice Address - Country:US
Practice Address - Phone:614-761-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist