Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2017017904 | MO |
NPI | 1114457058 |
---|---|
Provider Name | Dr. Cristina Hernandez |
First Address | Joplin, MO 64804-3612 |
Second Address | Joplin, MO 64801-3084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2017 |
Last Update Date | 13/06/2017 |