Individual
DR. JOSE A HERNANDEZ-GIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4577 S 4000 W, WEST VALLEY CITY, UT 84120-6222
(808) 966-0900
(801) 966-5046
Mailing address
PO BOX 403, TESUQUE, NM 87574-0403
(505) 780-8286
(505) 780-8286
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
CSDT-14
HI
1223G0001X
General Practice Dentistry
Primary
DD 1927
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8677334-9922
UTAH DENTAL LICENSE
UT
01
—
DD1927
DENTAL LICENSE
NM
Enumeration date
06/10/2009
Last updated
02/07/2014
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