Provider Demographics
NPI:1033289418
Name:HERRERA, RODOLFO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:HERRERA
Suffix:JR
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 1:17 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4146
Mailing Address - Country:US
Mailing Address - Phone:830-775-4122
Mailing Address - Fax:
Practice Address - Street 1:17 PAGE AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4146
Practice Address - Country:US
Practice Address - Phone:830-775-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB18586-01OtherCHIP