MEDICARE: DAVID HERNANDEZ DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	7411	NV

General Provider Information

NPI Number	:	1851906440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID HERNANDEZ DDS

Provider Business Mailing Address
First Line	:	1510 GRAPE ARBOR WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-0669
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6680 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2189
Country	:	US
Telephone Number	:	702-541-2828
Fax Number	:

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	01/29/2021

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