Provider Demographics
NPI:1043903362
Name:HERNANDEZ GONZALEZ, JUAN RAMON (DDS)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:RAMON
Last Name:HERNANDEZ GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LAKE POINTE DR APT 311
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3549
Mailing Address - Country:US
Mailing Address - Phone:316-395-2069
Mailing Address - Fax:
Practice Address - Street 1:5810 S UNIVERSITY DR STE 128
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6109
Practice Address - Country:US
Practice Address - Phone:800-304-9964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN308611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice