Provider Demographics
NPI:1417015173
Name:HERNANDEZ, ARTHUR JOEL (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:JOEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W BITTERS RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7852
Mailing Address - Country:US
Mailing Address - Phone:210-408-7182
Mailing Address - Fax:210-408-7993
Practice Address - Street 1:1202 W BITTERS RD BLDG 5
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7852
Practice Address - Country:US
Practice Address - Phone:210-408-7182
Practice Address - Fax:210-408-7993
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110907601Medicaid
TX110907603Medicaid
TX110907601Medicaid