Provider Demographics
NPI:1184315723
Name:HERNANDEZ, DILLON C (DMD)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:C
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 1:12625 BRADY PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2590
Mailing Address - Country:US
Mailing Address - Phone:229-560-0056
Mailing Address - Fax:
Practice Address - Street 1:1520 BUSINESS CENTER DR STE 3
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7480
Practice Address - Country:US
Practice Address - Phone:904-773-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty