Active NPI
Hiran R Fernando, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Clayton, MO
National Provider Identifier
1164634135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 2011001387
- Practice address
- 165 N. Meramec Ave
Suite 300
Clayton, MO 63105-3772 - Phone
- (314) 726-2755
- Fax
- (314) 726-9538
- NPI assigned
- May 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 23369 | TX | |
| Student in an Organized Health Care Education/Training Program | 390200000X | P56783 | NY | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 2011001387 | MO | Primary |
Addresses
Primary practice location
165 N. Meramec Ave
Suite 300
Clayton, MO 63105-3772
Mailing address
165 N. Meramec Ave
Suite 300
Clayton, MO 63105-3772
Phone (314) 726-2755
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Previously, effective Sep 14, 2012 through Sep 14, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23369 | TX | MD | Dentist |
| 2011001387 | MO | MD | Oral and Maxillofacial Surgery (Dentist) |
| P56783 | NY | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Oral and Maxillofacial Surgeons of St Louis, P.C. | Oral and Maxillofacial Surgery | Current | Accepting new patients |
Locations
165 N Meramec Ave
Ste 300
Clayton, MO 63105
Phone (314) 726-2755
4585 Washington St
Ste B4
Florissant, MO 63033
Phone (314) 726-2755
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Oral and Maxillofacial Surgery (Dentist)
- Clayton, MO
- NPI 1184892028
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681171200000",
"number": "1164634135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 N. MERAMEC AVE",
"address_2": "SUITE 300",
"city": "CLAYTON",
"state": "MO",
"postal_code": "631053772",
"telephone_number": "314-726-2755",
"fax_number": "314-726-9538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 N. MERAMEC AVE",
"address_2": "SUITE 300",
"city": "CLAYTON",
"state": "MO",
"postal_code": "631053772",
"telephone_number": "314-726-2755",
"fax_number": "314-726-9538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDO",
"first_name": "HIRAN",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-04",
"last_updated": "2023-04-11",
"certification_date": "2023-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "23369",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NY",
"license": "P56783",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "MO",
"license": "2011001387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Clayton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.