Provider Demographics
NPI:1477698363
Name:HERNANDEZ, ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:HERNANDEZ
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:CALLE ISLA NENA F19 REPARTO FLAMINGO
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-779-4049
Mailing Address - Fax:787-785-7125
Practice Address - Street 1:F19 CALLE ISLA NENA
Practice Address - Street 2:REPARTO FLAMINGO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-4936
Practice Address - Country:US
Practice Address - Phone:787-779-4049
Practice Address - Fax:787-785-7125
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice