Healthcare Provider Details

I. General information

NPI: 1982928172
Provider Name (Legal Business Name): ENRIQUE HERNANDEZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13065 E 17TH AVE MAIL STOP F849
AURORA CO
80045-2532
US

IV. Provider business mailing address

13065 E 17TH AVE MAIL STOP F849
AURORA CO
80045-2532
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-6995
  • Fax:
Mailing address:
  • Phone: 303-724-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9973
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: