Provider Demographics
NPI:1891902987
Name:STEVEN D. HERNANDEZ, D.D.S. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:STEVEN D. HERNANDEZ, D.D.S. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-332-4596
Mailing Address - Street 1:2652 SADDLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3838
Mailing Address - Country:US
Mailing Address - Phone:626-332-4596
Mailing Address - Fax:
Practice Address - Street 1:9560 BASELINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-6435
Practice Address - Country:US
Practice Address - Phone:909-987-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty