Provider Demographics
NPI:1558728436
Name:HERNANDEZ, JESUS LEONARDO (DDS)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:LEONARDO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 SHUMARD OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3887
Mailing Address - Country:US
Mailing Address - Phone:210-998-2074
Mailing Address - Fax:
Practice Address - Street 1:150 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061
Practice Address - Country:US
Practice Address - Phone:830-334-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist