MEDICARE: DILLON C HERNANDEZ DMD, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1821951872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DILLON C HERNANDEZ DMD, PLLC

Provider Business Mailing Address
First Line	:	9401 WAYPOINT PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-9229
Country	:	US
Telephone Number	:	904-733-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	9401 WAYPOINT PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-9229
Country	:	US
Telephone Number	:	229-560-0056
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. DILLON COLE HERNANDEZ
Credential	:	DMD
Telephone Number	:	229-560-0056

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/06/2025

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