Provider Demographics
NPI:1922521285
Name:HERNANDEZ DENTAL CARE
Entity Type:Organization
Organization Name:HERNANDEZ DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-451-3931
Mailing Address - Street 1:9204 TAYLORSVILLE RD STE 119
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1788
Mailing Address - Country:US
Mailing Address - Phone:502-451-3931
Mailing Address - Fax:502-451-3933
Practice Address - Street 1:9204 TAYLORSVILLE RD STE 119
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1788
Practice Address - Country:US
Practice Address - Phone:502-451-3931
Practice Address - Fax:502-451-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8817261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental