Healthcare Provider Details

I. General information

NPI: 1114457793
Provider Name (Legal Business Name): MARIO J HERNANDEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 NW 36TH ST
MIAMI FL
33127-3107
US

IV. Provider business mailing address

157 NW 36TH ST
MIAMI FL
33127-3107
US

V. Phone/Fax

Practice location:
  • Phone: 305-878-0263
  • Fax: 786-863-7669
Mailing address:
  • Phone: 305-878-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: