Alexander Erasto Hernandez, DMD
Individual provider Active NPI General Practice Dentistry · Saint Louis, MO
NPI 1164081980 · NPPES record last updated Jun 6, 2019
Key facts
- NPI
- 1164081980
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2019018446 (MO)
- Practice address
- 8859 Ladue Rd
Saint Louis, MO 63124-2045 - Phone
- (314) 983-8011
- Fax
- (314) 983-8112
- NPI assigned
- Jun 6, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190927003072 | MO | Order and Referring Only - Dentist |
5698005916 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019018446 | MO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bryan Watanabe DDS Ladue Dental Group, PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2019018446 | MO | Yes |
Addresses
Primary practice location
8859 Ladue Rd
Saint Louis, MO 63124-2045
Mailing address
8859 Ladue Rd
Saint Louis, MO 63124-2045
Phone (314) 983-8011
Other providers in Saint Louis, MO
- Daniela Hermelin
- Ruben Alfonso Hernandez Acosta
- Maday Hernandez-Fernandez
- Milarys Hernandez-Martinez
- Maryjo Hernandez-Zipfel
- Aylin Hernandez
- Dagmara Hernandez
- Deborah Hernandez
- Guillermo Eloy Hernandez
- Jesus Mariano Hernandez
All providers in Saint Louis, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.