Provider Demographics
NPI:1134829450
Name:HERNANDEZ, PEDRO NOE (DMD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:NOE
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 1:885 HARRISON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4073
Mailing Address - Country:US
Mailing Address - Phone:747-226-9505
Mailing Address - Fax:
Practice Address - Street 1:885 HARRISON AVE APT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4073
Practice Address - Country:US
Practice Address - Phone:747-226-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1860025122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist