Provider Demographics
NPI:1245749811
Name:HERRINGTON, CAROL MATTLAGE (DDS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MATTLAGE
Last Name:HERRINGTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 S ROYALL ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5000
Mailing Address - Country:US
Mailing Address - Phone:903-723-4226
Mailing Address - Fax:
Practice Address - Street 1:824 S ROYALL ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5000
Practice Address - Country:US
Practice Address - Phone:903-723-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice