Provider Demographics
NPI:1386660827
Name:HERNDON, JAMES K (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:HERNDON
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 1:5710 CLUB HILL CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1101
Mailing Address - Country:US
Mailing Address - Phone:972-248-0727
Mailing Address - Fax:
Practice Address - Street 1:17110 DALLAS PKWY STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1127
Practice Address - Country:US
Practice Address - Phone:972-407-1333
Practice Address - Fax:972-407-1681
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice