Provider Demographics
NPI:1154877298
Name:HERNANDEZ, JESUS EMMANUEL (DDS)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:EMMANUEL
Last Name:HERNANDEZ
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 1:10933 DELAFIELD DR.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-235-9603
Mailing Address - Fax:915-855-2371
Practice Address - Street 1:IGNACIO MEJIA YRAMON CORONA #409
Practice Address - Street 2:
Practice Address - City:CD. JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:3200
Practice Address - Country:MX
Practice Address - Phone:915-235-9603
Practice Address - Fax:915-855-2371
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ57036621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice