Healthcare Provider Details

I. General information

NPI: 1093659898
Provider Name (Legal Business Name): ALVARO HERNANDEZ DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BRISTOL ST STE 550
COSTA MESA CA
92626-7323
US

IV. Provider business mailing address

1932 ROLLINGSTONE LN
TUSTIN CA
92780-3953
US

V. Phone/Fax

Practice location:
  • Phone: 714-863-2414
  • Fax:
Mailing address:
  • Phone: 714-863-2414
  • Fax:

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: ALVARO HERNANDEZ
Title or Position: CEO
Credential: DDS
Phone: 714-863-2414