Healthcare Provider Details

I. General information

NPI: 1689714297
Provider Name (Legal Business Name): ALFIO J HERNANDEZ D.D.S., C.A.G.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 COMMONWEALTH AVE
BOSTON MA
02215-1274
US

IV. Provider business mailing address

1756 COLUMBIA RD APT. 2
BOSTON MA
02127-3410
US

V. Phone/Fax

Practice location:
  • Phone: 617-358-1000
  • Fax: 617-358-1010
Mailing address:
  • Phone: 617-269-9766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9369
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: