Provider Demographics
NPI:1972614154
Name:HERNANDEZ, ANTHONY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:R
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 1:5116 AMERICAN FAMILY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-8331
Mailing Address - Country:US
Mailing Address - Phone:608-825-7500
Mailing Address - Fax:608-825-0010
Practice Address - Street 1:5116 AMERICAN FAMILY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-8331
Practice Address - Country:US
Practice Address - Phone:608-825-7500
Practice Address - Fax:608-825-0010
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00054881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33774400Medicaid