Provider Demographics
NPI:1720100639
Name:HERNANDEZ, STEVEN P (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:P
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 1:1097 WESTON DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122
Mailing Address - Country:US
Mailing Address - Phone:615-758-7745
Mailing Address - Fax:615-758-7615
Practice Address - Street 1:1097 WESTON DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122
Practice Address - Country:US
Practice Address - Phone:615-758-7745
Practice Address - Fax:615-758-7615
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8635OtherLICENSE NUMBER