Healthcare Provider Details

I. General information

NPI: 1043074545
Provider Name (Legal Business Name): NATHALIA HERNANDEZ D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 KING ST
BRISTOL CT
06010-4477
US

IV. Provider business mailing address

4338 MADISON AVE
TRUMBULL CT
06611-2716
US

V. Phone/Fax

Practice location:
  • Phone: 860-583-8469
  • Fax:
Mailing address:
  • Phone: 203-520-7245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14723
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: