Provider Demographics
NPI:1033289657
Name:HERZER, DEIRDRE S (CPDH COLLABORATIVE P)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:S
Last Name:HERZER
Suffix:
Gender:F
Credentials:CPDH COLLABORATIVE P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 SILVER SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2243
Mailing Address - Country:US
Mailing Address - Phone:505-256-3509
Mailing Address - Fax:
Practice Address - Street 1:3003 SILVER SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2243
Practice Address - Country:US
Practice Address - Phone:505-256-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH802124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1800372OtherUNITED CONCORDIA