Provider Demographics
NPI:1811415417
Name:HERNANDEZ, JESSICA (RDH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-3814
Mailing Address - Country:US
Mailing Address - Phone:720-325-0942
Mailing Address - Fax:
Practice Address - Street 1:2530 S PARKER RD, SUITE 201
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-309-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-03
Last Update Date:2017-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002024879124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist