Provider Demographics
NPI:1467445395
Name:HERNANDEZ-MARTINEZ, WILFREDO J (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:J
Last Name:HERNANDEZ-MARTINEZ
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:URB SAN AGUSTIN
Mailing Address - Street 2:1175 CALLE MAXIMO ALOMAR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3231
Mailing Address - Country:US
Mailing Address - Phone:787-764-1173
Mailing Address - Fax:787-764-1338
Practice Address - Street 1:URB SAN AGUSTIN
Practice Address - Street 2:1175 CALLE MAXIMO ALOMAR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3231
Practice Address - Country:US
Practice Address - Phone:787-764-1173
Practice Address - Fax:787-764-1338
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist