Provider Demographics
NPI:1013030212
Name:HERDOIZA, PATRICIO (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICIO
Middle Name:
Last Name:HERDOIZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 KENTLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5446
Mailing Address - Country:US
Mailing Address - Phone:301-987-5200
Mailing Address - Fax:301-987-5511
Practice Address - Street 1:237 KENTLANDS BLVD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5446
Practice Address - Country:US
Practice Address - Phone:301-987-5200
Practice Address - Fax:301-987-5511
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist