Healthcare Provider Details

I. General information

NPI: 1912826926
Provider Name (Legal Business Name): MARIO JOSE HERNANDEZ DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 NW 36TH ST
MIAMI FL
33127-3107
US

IV. Provider business mailing address

362 NE 208TH TER
MIAMI FL
33179-2219
US

V. Phone/Fax

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

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: DR. MARIO JOSE HERNANDEZ
Title or Position: DENTIST
Credential: DDS
Phone: 305-878-0263