Provider Demographics
NPI:1093801656
Name:HERALD, DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HERALD
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 1:199 S CANDY LN
Mailing Address - Street 2:SUITE 4-A
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4183
Mailing Address - Country:US
Mailing Address - Phone:928-634-8046
Mailing Address - Fax:928-649-0856
Practice Address - Street 1:199 S CANDY LN
Practice Address - Street 2:SUITE 4-A
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4183
Practice Address - Country:US
Practice Address - Phone:928-634-8046
Practice Address - Fax:928-649-0856
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist