| Organization Name: | MARIO HERNADEZ, DDS, INC |
| NPI Number: | 1417098260 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIO HERNANDEZ (DENTIST) |
| Mailing Address: | 1870 Forest Hill Blvd Suite 103 Lake Clarke Shores |
| State: | FL US |
| Postal Code: | 334068901 |
| Phone Number: | 5615855891 |
| Fax Number: | 5615866014 |
| NPI Enumeration Date: | 02/12/2007 |
| NPI Last Update Date: | 02/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 13087 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |