Individual
ANDREA TANTENGCO HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1121 W MICHIGAN ST, INDIANAPOLIS, IN 46202-5211
(317) 702-2058
Mailing address
815 LOCKEFIELD ST APT G, INDIANAPOLIS, IN 46202-2936
(317) 702-2058
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
LDR200264
IN
390200000X
Student in an Organized Health Care Education/Training Program
LDR200264
IN
Other
Enumeration date
05/31/2022
Last updated
05/31/2022
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