Provider Demographics
NPI:1710294129
Name:HERNANDEZ, JOSE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:J
Last Name:HERNANDEZ
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 1:2220 BASSETT AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-2020
Mailing Address - Country:US
Mailing Address - Phone:915-859-3565
Mailing Address - Fax:817-755-2076
Practice Address - Street 1:P. TRIUNFO DE LA REPUBLICA 4020
Practice Address - Street 2:PLAZA RENACIMIENTO
Practice Address - City:JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32320
Practice Address - Country:MX
Practice Address - Phone:915-859-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ15484241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice