Provider Demographics
NPI:1679085849
Name:HERNANDEZ, NORMA L (RDH)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 NW 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3407
Mailing Address - Country:US
Mailing Address - Phone:954-682-3735
Mailing Address - Fax:
Practice Address - Street 1:5340 NW 125TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3407
Practice Address - Country:US
Practice Address - Phone:954-682-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-28
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH20743124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist