Provider Demographics
NPI:1699086090
Name:HERNANDEZ, JOE WILLIAM JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:WILLIAM
Last Name:HERNANDEZ
Suffix:JR
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 1:1347 FAIR AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-1437
Mailing Address - Country:US
Mailing Address - Phone:210-533-8191
Mailing Address - Fax:210-533-5928
Practice Address - Street 1:1347 FAIR AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1437
Practice Address - Country:US
Practice Address - Phone:210-533-8191
Practice Address - Fax:210-533-5928
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist