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General NPI Number Information
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NPI Number | 1861083396
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Entity Type | Individual
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Provider Name | MARTIN JUAN HERNANDEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 4016 CORTEZ RD W STE 1101
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City | BRADENTON
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State | FL
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Zip | 34210-3117
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Country | US
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Telephone | 941-756-4999
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Fax |
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Provider Business Mailing Address
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Address Line | 5852 SANDY POINTE DR
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City | SARASOTA
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State | FL
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Zip | 34233-3514
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Country | US
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Telephone | 941-544-0146
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2023000828
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 105907
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2023000828
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30118
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License Number State | FL
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