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General NPI Number Information
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NPI Number | 1033524285
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Entity Type | Organization
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Legal Business Name | DR ANTONIO HERNANDEZ LLC
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | F19 CALLE ISLA NENA REPARTO FLAMINGO
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City | BAYAMON
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State | PR
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Zip | 00959-4936
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Country | US
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Telephone | 787-779-4049
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Fax | 787-785-7125
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Provider Business Mailing Address
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Address Line | CALLE 6 URB LA MILAGROSA CENTRO COMERCIAL LA MILAGROSA OF5
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City | BAYAMON
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State | PR
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Zip | 00959
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Country | US
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Telephone | 787-779-4049
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Fax | 787-785-7125
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ANTONIO HERNANDEZ
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Credential | DMD
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Telephone | 787-779-4049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2505
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License Number State | PR
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