Provider Demographics
NPI:1720258395
Name:HILL COUNTRY PEDIATRIC DENISTRY PA
Entity type:Organization
Organization Name:HILL COUNTRY PEDIATRIC DENISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-693-7044
Mailing Address - Street 1:608 GATEWAY CENTRAL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654
Mailing Address - Country:US
Mailing Address - Phone:830-693-7044
Mailing Address - Fax:830-693-2069
Practice Address - Street 1:608 GATEWAY CENTRAL
Practice Address - Street 2:SUITE 201
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-693-7044
Practice Address - Fax:830-693-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200811223P0221X
TX198181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty