=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902220700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NILO A. HERNANDEZ JR., DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2014
-----------------------------------------------------
Last Update Date | 02/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6280 SUNSET DR SUITE 401
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-4827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-282-5296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6280 SUNSET DR SUITE 401
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-4827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-282-5296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ELIANA HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-282-5296
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN12716
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------