Provider Demographics
NPI:1164081980
Name:HERNANDEZ, ALEXANDER ERASTO (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ERASTO
Last Name:HERNANDEZ
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 1:8859 LADUE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2045
Mailing Address - Country:US
Mailing Address - Phone:314-983-8011
Mailing Address - Fax:314-983-8112
Practice Address - Street 1:8859 LADUE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2045
Practice Address - Country:US
Practice Address - Phone:314-983-8011
Practice Address - Fax:314-983-8112
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190184461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice