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General NPI Number Information
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NPI Number | 1477110369
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Entity Type | Individual
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Provider Name | LAUREN BROOKE HERNANDEZ DMD
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Gender | Female
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Dates
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Enumeration Date | 05/25/2019
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Last Update Date | 05/25/2019
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Provider Practice Location Address
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Address Line | 904 LILY CREEK RD
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City | LOUISVILLE
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State | KY
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Zip | 40243-2816
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Country | US
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Telephone | 502-409-4299
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Fax |
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Provider Business Mailing Address
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Address Line | 11802 DUANE POINT CIR APT 103
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City | LOUISVILLE
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State | KY
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Zip | 40243-1767
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Country | US
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Telephone | 703-586-2282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10275
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License Number State | KY
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