MEDICARE: J.W HERNANDEZ JR. DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1043873060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.W HERNANDEZ JR. DDS PC

Provider Business Mailing Address
First Line	:	1347 FAIR AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1437
Country	:	US
Telephone Number	:	210-533-8191
Fax Number	:	210-533-5928

Provider Business Practice Location Address
First Line	:	1347 FAIR AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-1437
Country	:	US
Telephone Number	:	210-533-8191
Fax Number	:	210-533-5928

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ANNA HERNANDEZ
Credential	:
Telephone Number	:	210-533-8191

Provider Enumeration Date	:	04/16/2019
Last Update Date	:	04/16/2019

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