Provider Demographics
NPI:1275797086
Name:HERRERA, MAURICIO JOSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:JOSE
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MAURICIO
Other - Middle Name:J
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11545 A NUCKOIS ROAD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5666
Mailing Address - Country:US
Mailing Address - Phone:804-673-8061
Mailing Address - Fax:804-673-5644
Practice Address - Street 1:10601 GREENYARD WAY STE B
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1485
Practice Address - Country:US
Practice Address - Phone:804-472-8099
Practice Address - Fax:804-270-4873
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413331204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery