Provider Demographics
NPI:1689706293
Name:HERNANDEZ DENTAL CARE, INC
Entity Type:Organization
Organization Name:HERNANDEZ DENTAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-318-0700
Mailing Address - Street 1:2106 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2862
Mailing Address - Country:US
Mailing Address - Phone:956-318-0700
Mailing Address - Fax:956-318-0781
Practice Address - Street 1:2106 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-2862
Practice Address - Country:US
Practice Address - Phone:956-318-0700
Practice Address - Fax:956-318-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168401223G0001X
TX217861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21786-01OtherCHIP ID# DR. VASQUEZ
TX01637598OtherTRICARE ID# DR. VASQUEZ
TX0848794OtherTRICARE ID# DR. HERNANDEZ
TXB16840-01OtherCHIPS ID # DR. HERNANDEZ