Provider Demographics
NPI:1831390624
Name:HERNANDEZ, JORGE OCTAVIO (DDS)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:OCTAVIO
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 1:6080 BIRD RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5233
Mailing Address - Country:US
Mailing Address - Phone:305-665-6564
Mailing Address - Fax:305-665-9370
Practice Address - Street 1:6080 BIRD RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5233
Practice Address - Country:US
Practice Address - Phone:305-665-6564
Practice Address - Fax:305-665-9370
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice