Provider Demographics
NPI:1619272747
Name:HERNANDEZ, JUAN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
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 1:85 TERRA DEL MONTE
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9007
Mailing Address - Country:US
Mailing Address - Phone:787-403-9194
Mailing Address - Fax:
Practice Address - Street 1:CARR 1 KM 55.2 BO MONTELLANO
Practice Address - Street 2:ALTOS CARIBBEAN CINEMAS PLAZA CAYEY
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-5419
Practice Address - Country:US
Practice Address - Phone:787-403-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist