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General NPI Number Information
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NPI Number | 1770102055
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Entity Type | Individual
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Provider Name | LAURA HERNANDEZ RDH
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Gender | Female
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 2350 BELMONT CIR SE
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City | SMYRNA
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State | GA
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Zip | 30080-1568
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Country | US
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Telephone | 678-842-9912
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Fax |
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Provider Business Mailing Address
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Address Line | 1547 RIVER WALK TRL APT B
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5774
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Country | US
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Telephone |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH043485
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License Number State | GA
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