Provider Demographics
NPI:1417012865
Name:HERNANDEZ, SANDRA IVETTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:IVETTE
Last Name:HERNANDEZ
Suffix:
Gender:F
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:PO BOX 191705
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1705
Mailing Address - Country:US
Mailing Address - Phone:787-285-6213
Mailing Address - Fax:
Practice Address - Street 1:358 CALLE FONT MARTELO
Practice Address - Street 2:STE. 104
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3222
Practice Address - Country:US
Practice Address - Phone:787-285-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice