Provider Demographics
NPI:1700679818
Name:HERNANDEZ PARRA, EDGAR ALEXANDER (DMD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ALEXANDER
Last Name:HERNANDEZ PARRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 ROOSEVELT AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1245
Mailing Address - Country:US
Mailing Address - Phone:786-470-6603
Mailing Address - Fax:
Practice Address - Street 1:705 HOBBS HWY
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3401
Practice Address - Country:US
Practice Address - Phone:432-245-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03092500122300000X
TX41446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist