Provider Demographics
NPI:1023168754
Name:HERNANDEZ, ROGELIO PEREZ (DMD)
Entity type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:PEREZ
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W 7TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:559-582-4349
Mailing Address - Fax:559-582-8064
Practice Address - Street 1:425 W 7TH ST
Practice Address - Street 2:SUITE 104 HANFORD FAMILY DENTAL
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-582-4349
Practice Address - Fax:559-582-8064
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist