Provider Demographics
NPI:1437632460
Name:HERNANDEZ MERCADO, JOSE MILTON
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MILTON
Last Name:HERNANDEZ MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19038 YELLOWSTONE LANDING CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-8132
Mailing Address - Country:US
Mailing Address - Phone:713-754-0249
Mailing Address - Fax:
Practice Address - Street 1:13649 EASTLAKE BLVD
Practice Address - Street 2:SUITE E2 AND E3
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928
Practice Address - Country:US
Practice Address - Phone:915-235-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice