MEDICARE: DR. JOSE LUIS HERNANDEZ DMD

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	1294	PR

General Provider Information

NPI Number	:	1669479028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS HERNANDEZ DMD

Provider Business Mailing Address
First Line	:	MARGINAL VILLAMAR
Second Line	:	#35
City	:	CAROLINA
State	:	PR
Zip	:	00979
Country	:	US
Telephone Number	:	787-726-0503
Fax Number	:	787-727-5916

Provider Business Practice Location Address
First Line	:	MARGINAL VILLAMAR
Second Line	:	#35
City	:	CAROLINA
State	:	PR
Zip	:	00979
Country	:	US
Telephone Number	:	787-726-0503
Fax Number	:	787-727-5916

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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