Individual
JOHNNY J HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10 HEARTLAND DR, SUITE A, BLOOMINGTON, IL 61704-7741
(309) 662-0523
(309) 662-7693
Mailing address
13715 FAWN DR, BLOOMINGTON, IL 61704-7834
(309) 828-1110
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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