Healthcare Provider Details

I. General information

NPI: 1619774106
Provider Name (Legal Business Name): STEPHANIE HERNANDEZ DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S MARYLAND PKWY
LAS VEGAS NV
89104-1728
US

IV. Provider business mailing address

1212 S MARYLAND PKWY
LAS VEGAS NV
89104-1728
US

V. Phone/Fax

Practice location:
  • Phone: 725-291-5588
  • Fax:
Mailing address:
  • Phone: 725-291-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE HERNANDEZ
Title or Position: OWNER
Credential: DMD
Phone: 725-291-5588