MEDICARE: DR. JORGE L HERNANDEZ D.M.D

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	1223P0700X	Prosthodontics	2768	PR
2	1223P0700X	Prosthodontics	30547	TX

General Provider Information

NPI Number	:	1558568402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE L HERNANDEZ D.M.D

Provider Business Mailing Address
First Line	:	1706 YELLOW IRIS TRL
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5010
Country	:	US
Telephone Number	:	787-948-8489
Fax Number	:

Provider Business Practice Location Address
First Line	:	11901 SHADOW CREEK PKWY STE 135
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7346
Country	:	US
Telephone Number	:	281-206-2211
Fax Number	:

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	01/07/2021

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