MEDICARE: HEILYN 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	122300000X	Dentist	DN23615	FL

General Provider Information

NPI Number	:	1346726833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEILYN HERNANDEZ DMD

Provider Business Mailing Address
First Line	:	7425 W 24TH AVE APT 104
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-6568
Country	:	US
Telephone Number	:	786-470-6615
Fax Number	:

Provider Business Practice Location Address
First Line	:	7425 W 24TH AVE APT 104
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016
Country	:	US
Telephone Number	:	786-470-6615
Fax Number	:

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

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	07/17/2018

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