Healthcare Provider Details

I. General information

NPI: 1225480809
Provider Name (Legal Business Name): EMILIO ROBERTO HERNANDEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 FOUNDRY ST STE 202
CONCORD NH
03301-9914
US

IV. Provider business mailing address

16 FOUNDRY ST STE 202
CONCORD NH
03301-9914
US

V. Phone/Fax

Practice location:
  • Phone: 603-333-2538
  • Fax:
Mailing address:
  • Phone: 603-333-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDT2643
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number04818
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: