Provider Demographics
NPI:1376051425
Name:HERRERA, ROXANNE RAMIREZ (DDS)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:RAMIREZ
Last Name:HERRERA
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 1:1047 E RUDDOCK ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2716
Mailing Address - Country:US
Mailing Address - Phone:626-641-8041
Mailing Address - Fax:
Practice Address - Street 1:266 S GLENDORA AVE STE A
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3042
Practice Address - Country:US
Practice Address - Phone:626-598-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS101587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist