Healthcare Provider Details

I. General information

NPI: 1699516609
Provider Name (Legal Business Name): ANA ISABELLA HERNANDEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 E CALUMET ST
APPLETON WI
54915-4104
US

IV. Provider business mailing address

4068 WILLOWTREE LN
DE PERE WI
54115-8650
US

V. Phone/Fax

Practice location:
  • Phone: 920-739-6808
  • Fax:
Mailing address:
  • Phone: 920-277-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDRPM2758
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6001475
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: