Provider Demographics
NPI:1558568402
Name:HERNANDEZ, JORGE L (DMD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
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 1:1706 YELLOW IRIS TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5010
Mailing Address - Country:US
Mailing Address - Phone:787-948-8489
Mailing Address - Fax:
Practice Address - Street 1:11901 SHADOW CREEK PKWY STE 135
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7346
Practice Address - Country:US
Practice Address - Phone:281-206-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27681223P0700X
TX305471223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics