Provider Demographics
NPI:1396349171
Name:SILVERA HERNANDEZ, RAUL J (DH)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:J
Last Name:SILVERA HERNANDEZ
Suffix:
Gender:M
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 LAUREL LEAF ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7527
Mailing Address - Country:US
Mailing Address - Phone:407-800-1101
Mailing Address - Fax:
Practice Address - Street 1:1229 PROVIDENCE BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7362
Practice Address - Country:US
Practice Address - Phone:386-574-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH27487124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist