=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982143210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN HERNANDEZ, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2017
-----------------------------------------------------
Last Update Date | 02/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8134 SAWYER BROWN RD
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37221-9998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-646-5595
-----------------------------------------------------
Fax | 615-646-5399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8134 SAWYER BROWN RD
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-646-5595
-----------------------------------------------------
Fax | 615-646-5399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEVEN HERNANDEZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 615-646-5595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8635
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------