Provider Demographics
NPI:1568079135
Name:ALFONZO HERNANDEZ, VERONICA VIRGINIA (DDS)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:VIRGINIA
Last Name:ALFONZO HERNANDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 SW 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5784
Mailing Address - Country:US
Mailing Address - Phone:786-603-8659
Mailing Address - Fax:
Practice Address - Street 1:10640 GRIFFIN RD STE 101
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3214
Practice Address - Country:US
Practice Address - Phone:954-252-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist