Provider Demographics
NPI:1669686028
Name:SERRANO, HECTOR M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:M
Last Name:SERRANO
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 1:3609 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1705
Mailing Address - Country:US
Mailing Address - Phone:301-814-2452
Mailing Address - Fax:
Practice Address - Street 1:11228 GEORGIA AVE STE 12
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4694
Practice Address - Country:US
Practice Address - Phone:301-929-0244
Practice Address - Fax:301-929-0244
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice