Provider Demographics
NPI:1265446504
Name:HERD, GREGORY JOHN (DDS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOHN
Last Name:HERD
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 1:30212 TOMAS
Mailing Address - Street 2:SUITE 330
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688
Mailing Address - Country:US
Mailing Address - Phone:949-858-5147
Mailing Address - Fax:949-858-5165
Practice Address - Street 1:30212 TOMAS
Practice Address - Street 2:SUITE 330
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-858-5147
Practice Address - Fax:949-858-5165
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770602765OtherTAX ID#