Provider Demographics
NPI:1992069371
Name:HERNANDEZ, IDALIA (DDS)
Entity type:Individual
Prefix:DR
First Name:IDALIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8060 SW 152ND AVE
Mailing Address - Street 2:# 501
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1328
Mailing Address - Country:US
Mailing Address - Phone:786-853-0569
Mailing Address - Fax:
Practice Address - Street 1:8726 NW 26TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1627
Practice Address - Country:US
Practice Address - Phone:305-591-8044
Practice Address - Fax:305-591-7533
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN197661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice