Provider Demographics
NPI:1578821708
Name:PEOPLE DENTAL
Entity Type:Organization
Organization Name:PEOPLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-783-9154
Mailing Address - Street 1:784 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1941
Mailing Address - Country:US
Mailing Address - Phone:559-783-9154
Mailing Address - Fax:
Practice Address - Street 1:784 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1941
Practice Address - Country:US
Practice Address - Phone:559-783-9154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42283OtherALL OTHER INSURANCE
CAG9369001OtherDENI-CAL ID
CA7223480OtherUNITED CONCORDIA