=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629684402
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMON NOEL HERNANDEZ DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2020
-----------------------------------------------------
Last Update Date | 09/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13000 N INTERSTATE 35 STE 206
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78753-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-815-2524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 BARTON SKWY APT 1503
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78746-7555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-385-4586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 36679
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------