Provider Demographics
NPI:1689342545
Name:HERNANDEZ VILLALVAZO, HECTOR DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:DANIEL
Last Name:HERNANDEZ VILLALVAZO
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 1:17008 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:CA
Mailing Address - Zip Code:93234
Mailing Address - Country:US
Mailing Address - Phone:800-492-4227
Mailing Address - Fax:
Practice Address - Street 1:17008 13TH STREET, HURON, CA 93234.
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:CA
Practice Address - Zip Code:93234
Practice Address - Country:US
Practice Address - Phone:800-492-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist