Provider Demographics
NPI:1083840250
Name:HERR, SHUE
Entity Type:Individual
Prefix:DR
First Name:SHUE
Middle Name:
Last Name:HERR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 PEARCE CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2457
Mailing Address - Country:US
Mailing Address - Phone:770-536-6688
Mailing Address - Fax:770-531-0975
Practice Address - Street 1:1419 PEARCE CIR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2457
Practice Address - Country:US
Practice Address - Phone:770-536-6688
Practice Address - Fax:770-531-0975
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND126591223G0001X
GADN014170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice