Provider Demographics
NPI:1932292232
Name:HERNANDEZ, GEORGIA (DMD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 MICHIGAN AVE.
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139
Mailing Address - Country:US
Mailing Address - Phone:305-532-3300
Mailing Address - Fax:305-538-8444
Practice Address - Street 1:1680 MICHIGAN AVE.
Practice Address - Street 2:SUITE 1020
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139
Practice Address - Country:US
Practice Address - Phone:305-532-3300
Practice Address - Fax:305-538-8444
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist