=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336138429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUZ JANETH HERNANDEZ DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2005
-----------------------------------------------------
Last Update Date | 07/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27650 CASHFORD CIR SUITE 101
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-6957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-903-8888
-----------------------------------------------------
Fax | 877-797-4054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27650 CASHFORD CIR SUITE 101
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-6957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-903-8888
-----------------------------------------------------
Fax | 877-797-4054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 17677
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------