Provider Demographics
NPI:1851396584
Name:HERNANDEZ, JUAN DIEGO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:DIEGO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DMD
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 390
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0390
Mailing Address - Country:US
Mailing Address - Phone:787-858-2744
Mailing Address - Fax:787-858-2744
Practice Address - Street 1:EXTENCION BETANCES #181
Practice Address - Street 2:ROAD 155 KM.66.8
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-2744
Practice Address - Fax:787-858-2744
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice