Provider Demographics
NPI:1063608057
Name:HERNANDEZ, OSCAR (DMD,PA)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DMD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 48TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1700
Mailing Address - Country:US
Mailing Address - Phone:941-753-1432
Mailing Address - Fax:941-753-8059
Practice Address - Street 1:2620 48TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1700
Practice Address - Country:US
Practice Address - Phone:941-753-1432
Practice Address - Fax:941-753-8059
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist