Provider Demographics
NPI:1083811491
Name:HERRERA, EPIFANIO DOMINGO (DDS)
Entity Type:Individual
Prefix:DR
First Name:EPIFANIO
Middle Name:DOMINGO
Last Name:HERRERA
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 1:4661 STOCKDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2614
Mailing Address - Country:US
Mailing Address - Phone:661-837-0435
Mailing Address - Fax:661-837-0850
Practice Address - Street 1:4661 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2614
Practice Address - Country:US
Practice Address - Phone:661-837-0435
Practice Address - Fax:661-837-0850
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice