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General NPI Number Information
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NPI Number | 1487391686
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Entity Type | Organization
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Legal Business Name | JERRY HERNANDEZ DENTAL CORPORATION
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 39252 WINCHESTER RD STE 117
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City | MURRIETA
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State | CA
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Zip | 92563-3511
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Country | US
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Telephone | 951-894-7769
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Fax |
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Provider Business Mailing Address
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Address Line | 39252 WINCHESTER RD STE 117
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City | MURRIETA
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State | CA
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Zip | 92563-3511
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Country | US
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Telephone | 951-894-7769
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Fax |
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Authorized Official
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Title or Position | DENTIS
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Name | JERRY HERNANDEZ
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Credential | DDS
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Telephone | 951-894-7769
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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 |
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License Number State |
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