Provider Demographics
NPI:1902926074
Name:HERNANDEZ, ERLYN PAPA (DMD)
Entity Type:Individual
Prefix:
First Name:ERLYN
Middle Name:PAPA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19999 STEVENS CREEK BLVD
Mailing Address - Street 2:UNIT 307
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014
Mailing Address - Country:US
Mailing Address - Phone:408-873-1447
Mailing Address - Fax:
Practice Address - Street 1:825 OAK GROVE AVE
Practice Address - Street 2:STE A 102
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-322-5381
Practice Address - Fax:650-329-7946
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics