Provider Demographics
NPI:1043328768
Name:HERKERT, GREGORY E (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:HERKERT
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 1:680 W HWY 20
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391
Mailing Address - Country:US
Mailing Address - Phone:541-336-2122
Mailing Address - Fax:541-336-1036
Practice Address - Street 1:680 W HWY 20
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391
Practice Address - Country:US
Practice Address - Phone:541-336-2122
Practice Address - Fax:541-336-1036
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice