MEDICARE: DR. SHEILA HERNANDEZ DMD

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	1223P0221X	Pediatric Dentistry	20560	TX

General Provider Information

NPI Number	:	1255458493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEILA HERNANDEZ DMD

Provider Business Mailing Address
First Line	:	8202 N LOOP 1604 W
Second Line	:	SUITE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2897
Country	:	US
Telephone Number	:	210-694-2700
Fax Number	:	210-694-2708

Provider Business Practice Location Address
First Line	:	8202 N LOOP 1604 W
Second Line	:	SUITE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2897
Country	:	US
Telephone Number	:	210-694-2700
Fax Number	:	210-694-2708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	10/01/2008

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