Andrea Tantengco Hernandez, DMD

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

LDR200264 Issued in IN

Practice address

1121 W Michigan St
Indianapolis, IN 46202-5211

Phone

(317) 702-2058

NPI assigned

May 31, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1043959042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 LOCKEFIELD ST APT G",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462022936",
            "telephone_number": "317-702-2058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025211",
            "telephone_number": "317-702-2058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "ANDREA",
        "middle_name": "TANTENGCO",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-31",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "IN",
            "license": "LDR200264",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "LDR200264",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tricia Hern, MD
• Ana Hernandez Calderon, PHARMD
• Ruben Hernan Hernandez Mondragon, MD
• Ilana B Hernandez-Ritter, BCBA
• Sharina Hernandez-Villalobos
• Anthony Adame Hernandez
• Brianna Hernandez
• Heidi Jane Alia Hernandez
• Jennifer Hernandez
• Jocelyne Hernandez, OTD, OTR

• Prosthodontics in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Prosthodontics in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.