Provider Demographics
NPI:1477110369
Name:HERNANDEZ, LAUREN BROOKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:BROOKE
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 1:11802 DUANE POINT CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1767
Mailing Address - Country:US
Mailing Address - Phone:703-586-2282
Mailing Address - Fax:
Practice Address - Street 1:904 LILY CREEK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2816
Practice Address - Country:US
Practice Address - Phone:502-409-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-25
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice