Provider Demographics
NPI:1134783038
Name:HERNANDEZ, CARLOS R (DDS, MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9646 W LOOP 1604 N
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6433
Mailing Address - Country:US
Mailing Address - Phone:210-625-7277
Mailing Address - Fax:
Practice Address - Street 1:9646 W LOOP 1604 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6433
Practice Address - Country:US
Practice Address - Phone:210-625-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX387271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery