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Organization
RIVERVIEW ENDODONTICS LLC
Active
Organization
RIVERVIEW ENDODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. INGMAR ANDREA HERNANDEZ DMD (OWNER DENTIST)
(239) 408-3636
Entity
Organization
Contact information
Practice address
27399 RIVERVIEW CENTER BLVD STE 104, BONITA SPRINGS, FL 34134-4311
(239) 408-3636
Mailing address
27399 RIVERVIEW CENTER BLVD STE 104, BONITA SPRINGS, FL 34134-4311
(239) 408-3636
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN24712
DENTAL LICENSE
FL
Enumeration date
08/29/2024
Last updated
08/29/2024
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