Provider Demographics
NPI:1821505496
Name:HERNANDEZ, CARLOS M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:M
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 1:7104 N FRESNO ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2970
Mailing Address - Country:US
Mailing Address - Phone:559-493-5697
Mailing Address - Fax:559-840-0851
Practice Address - Street 1:7104 N FRESNO ST STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2970
Practice Address - Country:US
Practice Address - Phone:559-493-5697
Practice Address - Fax:559-840-0851
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1022391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice