MEDICARE: DR. PEDRO J HERNANDEZ SR. D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22D102037400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275625824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRO J HERNANDEZ SR. D.D.S.

Provider Business Mailing Address
First Line	:	HERNANDEZ DENTAL OFFICE
Second Line	:	491 21 AVENUE FIRST FLOORS
City	:	PATERSON
State	:	NJ
Zip	:	07513-1656
Country	:	US
Telephone Number	:	973-247-9700
Fax Number	:	973-247-9781

Provider Business Practice Location Address
First Line	:	491 21 AVENUE FIRST FLOORS
Second Line	:	SUITE # 2
City	:	PATERSON
State	:	NJ
Zip	:	07513-1656
Country	:	US
Telephone Number	:	973-247-9700
Fax Number	:	973-247-9781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. PEDRO J HERNANDEZ SR. D.D.S.” Practice Location

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