Healthcare Provider Details

I. General information

NPI: 1891965802
Provider Name (Legal Business Name): JOSE MANUEL HERNANDEZ LORING DMD MPH MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 INF AVE KIM 14.7 LOS COLOBOS SH CTER CINEMA BUILD SUITE 201
CAROLINA PR
00987
US

IV. Provider business mailing address

PO BOX 361916
SAN JUAN PR
00936-1916
US

V. Phone/Fax

Practice location:
  • Phone: 787-776-0814
  • Fax: 787-776-0805
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number988
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: