=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073136271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIO E HERNANDEZ DMD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2020
-----------------------------------------------------
Last Update Date | 05/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 NE 24TH ST STE 105
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-4873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-572-1600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 NE 24TH ST STE 105
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-4873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-572-1600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JULIO E HERNANDEZ
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 305-572-1600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------