Provider Demographics
NPI:1285693267
Name:HERNANDEZ, NORBERTO J (DDS)
Entity type:Individual
Prefix:
First Name:NORBERTO
Middle Name:J
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 1:1470 NW 107TH AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2744
Mailing Address - Country:US
Mailing Address - Phone:305-594-8666
Mailing Address - Fax:305-594-0088
Practice Address - Street 1:1470 NW 107TH AVE
Practice Address - Street 2:SUITE G
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2744
Practice Address - Country:US
Practice Address - Phone:305-594-8666
Practice Address - Fax:305-594-0088
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 144511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071499200Medicaid