Individual provider Active NPI

Hiran R Fernando, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Clayton, MO
National Provider Identifier
1164634135
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
2011001387 Issued in MO
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

Updated by the provider on Apr 11, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.
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

LicenseStateTypeSpecialty
23369TXMDDentist
2011001387MOMDOral and Maxillofacial Surgery (Dentist)
P56783NYMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Oral and Maxillofacial Surgeons of St Louis, P.C. Oral and Maxillofacial Surgery CurrentSince Apr 16, 2023 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.

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

Verify at the official NPI Registry.