Provider Demographics
NPI:1164634135
Name:FERNANDO, HIRAN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:HIRAN
Middle Name:R
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N. MERAMEC AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3772
Mailing Address - Country:US
Mailing Address - Phone:314-726-2755
Mailing Address - Fax:314-726-9538
Practice Address - Street 1:165 N. MERAMEC AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3772
Practice Address - Country:US
Practice Address - Phone:314-726-2755
Practice Address - Fax:314-726-9538
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23369122300000X
NYP56783390200000X
MO20110013871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program