Provider Demographics
NPI:1407176001
Name:HERR, WILLIAM MONG (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MONG
Last Name:HERR
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 1:1310 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-3223
Mailing Address - Country:US
Mailing Address - Phone:770-339-4690
Mailing Address - Fax:770-339-4736
Practice Address - Street 1:1310 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011
Practice Address - Country:US
Practice Address - Phone:770-339-4690
Practice Address - Fax:770-339-4736
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014222122300000X
MND12826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6512832149Medicaid