Provider Demographics
NPI:1134117179
Name:HEROS, FRED C (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:C
Last Name:HEROS
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 1:3594 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3926
Mailing Address - Country:US
Mailing Address - Phone:901-377-6800
Mailing Address - Fax:901-377-5360
Practice Address - Street 1:3594 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3926
Practice Address - Country:US
Practice Address - Phone:901-377-6800
Practice Address - Fax:901-377-5360
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS29521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice