Healthcare Provider Details

I. General information

NPI: 1073136271
Provider Name (Legal Business Name): JULIO E HERNANDEZ DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NE 24TH ST STE 105
MIAMI FL
33137-4873
US

IV. Provider business mailing address

350 NE 24TH ST STE 105
MIAMI FL
33137-4873
US

V. Phone/Fax

Practice location:
  • Phone: 305-572-1600
  • Fax:
Mailing address:
  • Phone: 305-572-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIO E HERNANDEZ
Title or Position: OWNER
Credential: DMD
Phone: 305-572-1600