Individual
JONATHAN DAVID HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3013 LOOP 306, SAN ANGELO, TX 76904-6472
(325) 947-7777
Mailing address
3013 LOOP 306, SAN ANGELO, TX 76904-6472
(325) 947-7777
(325) 947-7771
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
36491
TX
1223P0221X
Pediatric Dentistry
Primary
36491
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36891
TEXAS STATE DENTAL BOARD
TX
Enumeration date
08/07/2020
Last updated
09/13/2024
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