Healthcare Provider Details

I. General information

NPI: 1194019638
Provider Name (Legal Business Name): RICHARD YEE HERNANDEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9097 E DESERT COVE AVE SUITE 240
SCOTTSDALE AZ
85260-6279
US

IV. Provider business mailing address

9097 E DESERT COVE AVE SUITE 240
SCOTTSDALE AZ
85260-6279
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-6541
  • Fax:
Mailing address:
  • Phone: 480-661-6541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD009285
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD009285
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD009285
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009285
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: