Provider Demographics
NPI:1689714297
Name:HERNANDEZ, ALFIO J (DDS, CAGS)
Entity Type:Individual
Prefix:DR
First Name:ALFIO
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DDS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 COLUMBIA RD
Mailing Address - Street 2:APT. 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-3410
Mailing Address - Country:US
Mailing Address - Phone:617-269-9766
Mailing Address - Fax:
Practice Address - Street 1:930 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1274
Practice Address - Country:US
Practice Address - Phone:617-358-1000
Practice Address - Fax:617-358-1010
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA93691223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics