Provider Demographics
NPI:1609452762
Name:HERNANDEZ LARA, ALAN SALVADOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SALVADOR
Last Name:HERNANDEZ LARA
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 1:3100 E SERVICE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-6422
Mailing Address - Country:US
Mailing Address - Phone:805-458-6051
Mailing Address - Fax:
Practice Address - Street 1:3100 E SERVICE RD STE 101
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-6422
Practice Address - Country:US
Practice Address - Phone:209-542-9921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1054851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice