Provider Demographics
NPI:1245563147
Name:HERRERA, DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:6549 N PALM AVE APT 159
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1069
Mailing Address - Country:US
Mailing Address - Phone:559-221-0302
Mailing Address - Fax:559-221-0326
Practice Address - Street 1:5359 N FRESNO ST # 110-F
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6831
Practice Address - Country:US
Practice Address - Phone:559-221-0302
Practice Address - Fax:559-221-0326
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist