Provider Demographics
NPI:1417187279
Name:HERNANDEZ GARCIA, MANUEL BENNETT (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:BENNETT
Last Name:HERNANDEZ GARCIA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAS CATALINAS SHOPPING CENTER
Mailing Address - Street 2:CINEMA BLDG. SUITE 202
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-743-2717
Mailing Address - Fax:
Practice Address - Street 1:LAS CATALINAS SHOPPING CENTER
Practice Address - Street 2:CINEMA BLDG. SUITE 202
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31811223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics