MEDICARE: LAURA HERNANDEZ RDH

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	124Q00000X	Dental Hygienist	DH043485	GA

General Provider Information

NPI Number	:	1770102055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HERNANDEZ RDH

Provider Business Mailing Address
First Line	:	1547 RIVER WALK TRL APT B
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-5774
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 BELMONT CIR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-1568
Country	:	US
Telephone Number	:	678-842-9912
Fax Number	:

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

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	04/15/2020

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Directions to “ LAURA HERNANDEZ RDH” Practice Location

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