Provider Demographics
NPI:1063498046
Name:HERRERA, MARIA DE JESUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DE JESUS
Last Name:HERRERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 91ST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7901
Mailing Address - Country:US
Mailing Address - Phone:718-205-4377
Mailing Address - Fax:718-205-8605
Practice Address - Street 1:3753 91ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7901
Practice Address - Country:US
Practice Address - Phone:718-205-4377
Practice Address - Fax:718-205-8605
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01161288Medicaid