Provider Demographics
NPI:1245338565
Name:HERNANDEZ, RUTSIE A (DMD)
Entity type:Individual
Prefix:
First Name:RUTSIE
Middle Name:A
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 1:7735 NW 146TH ST
Mailing Address - Street 2:SUITE#104
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1581
Mailing Address - Country:US
Mailing Address - Phone:305-556-7010
Mailing Address - Fax:
Practice Address - Street 1:7735 NW 146TH ST
Practice Address - Street 2:SUITE#104
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1581
Practice Address - Country:US
Practice Address - Phone:305-556-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN141851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice