=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821951872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DILLON C HERNANDEZ DMD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2025
-----------------------------------------------------
Last Update Date | 12/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9401 WAYPOINT PL
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32257-9229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-560-0056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9401 WAYPOINT PL
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32257-9229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-733-1900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. DILLON COLE HERNANDEZ
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 229-560-0056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------