Provider Demographics
NPI:1760509491
Name:HERNANDEZ DE PAZ, BERNARDO E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:E
Last Name:HERNANDEZ DE PAZ
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:C8 CALLE 3
Mailing Address - Street 2:VILLAS DE SAN FRANCISCO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6446
Mailing Address - Country:US
Mailing Address - Phone:787-876-6480
Mailing Address - Fax:787-876-6175
Practice Address - Street 1:4 CALLE CALDERON MUJICA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3213
Practice Address - Country:US
Practice Address - Phone:787-876-6480
Practice Address - Fax:787-876-6175
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice