Provider Demographics
NPI:1871803825
Name:HERNANDEZ, FLORENCIA (DDS)
Entity type:Individual
Prefix:MRS
First Name:FLORENCIA
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 1:2629 W ORANGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6874
Mailing Address - Country:US
Mailing Address - Phone:602-864-5558
Mailing Address - Fax:602-864-2451
Practice Address - Street 1:8256 E STATE ROUTE 69
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8403
Practice Address - Country:US
Practice Address - Phone:928-772-4433
Practice Address - Fax:928-772-5582
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD80951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice