Provider Demographics
NPI:1821038191
Name:HERNANDEZ, ANGEL IVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:IVAN
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:PO BOX 3654
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-3654
Mailing Address - Country:US
Mailing Address - Phone:787-858-2400
Mailing Address - Fax:787-858-2400
Practice Address - Street 1:URB. BRASILIA ST. MARGINAL M-19
Practice Address - Street 2:SUITE #3
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-2400
Practice Address - Fax:787-858-2400
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice