Provider Demographics
NPI:1437343738
Name:ANTHONY E. HERRO DDS,PLLC.
Entity Type:Organization
Organization Name:ANTHONY E. HERRO DDS,PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PLLC
Authorized Official - Phone:602-266-1776
Mailing Address - Street 1:5133 N CENTRAL AVE
Mailing Address - Street 2:200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1438
Mailing Address - Country:US
Mailing Address - Phone:602-266-1776
Mailing Address - Fax:
Practice Address - Street 1:5133 N CENTRAL AVE
Practice Address - Street 2:#102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1438
Practice Address - Country:US
Practice Address - Phone:602-266-1776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD67001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1972202OtherUNITED CONCORDIA