Provider Demographics
NPI:1235498684
Name:HEROLD FAMILY DENTISTRY
Entity Type:Organization
Organization Name:HEROLD FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEROLD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-436-3718
Mailing Address - Street 1:313 ISLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8221
Mailing Address - Country:US
Mailing Address - Phone:603-436-3718
Mailing Address - Fax:
Practice Address - Street 1:313 ISLINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-8221
Practice Address - Country:US
Practice Address - Phone:603-436-3718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH038431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty