MEDICARE: MRS. FLORENCIA 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	1223G0001X	General Practice Dentistry	D8095	AZ

General Provider Information

NPI Number	:	1871803825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FLORENCIA HERNANDEZ DDS

Provider Business Mailing Address
First Line	:	2629 W ORANGEWOOD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6874
Country	:	US
Telephone Number	:	602-864-5558
Fax Number	:	602-864-2451

Provider Business Practice Location Address
First Line	:	8256 E STATE ROUTE 69
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-8403
Country	:	US
Telephone Number	:	928-772-4433
Fax Number	:	928-772-5582

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

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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