Healthcare Provider Details

I. General information

NPI: 1659779734
Provider Name (Legal Business Name): HERNANDEZ & BUCK, A DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9560 BASELINE RD SUITE B
ALTA LOMA CA
91701-6435
US

IV. Provider business mailing address

9560 BASELINE RD SUITE B
ALTA LOMA CA
91701-6435
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-7676
  • Fax: 909-948-9413
Mailing address:
  • Phone: 909-987-7676
  • Fax: 909-948-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN D HERNANDEZ
Title or Position: OWNER/PARTNER
Credential: DDS
Phone: 909-987-7676