MEDICARE: DR. LAUREN BROOKE 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	1223G0001X	General Practice Dentistry	10275	KY

General Provider Information

NPI Number	:	1477110369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN BROOKE HERNANDEZ DMD

Provider Business Mailing Address
First Line	:	11802 DUANE POINT CIR APT 103
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-1767
Country	:	US
Telephone Number	:	703-586-2282
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 LILY CREEK RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2816
Country	:	US
Telephone Number	:	502-409-4299
Fax Number	:

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

Provider Enumeration Date	:	05/25/2019
Last Update Date	:	05/25/2019

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