Provider Demographics
NPI:1679800148
Name:HERNANDEZ, MARGARITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARGARITA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14 MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-847-0110
Mailing Address - Fax:978-878-8152
Practice Address - Street 1:14 MANNING AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5768
Practice Address - Country:US
Practice Address - Phone:978-847-0110
Practice Address - Fax:978-847-0112
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL130241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice