Provider Demographics
NPI:1477711539
Name:HERRIOTT, ANTUAN LATRELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTUAN
Middle Name:LATRELL
Last Name:HERRIOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ALPHA MILL LN APT 110
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-3312
Mailing Address - Country:US
Mailing Address - Phone:704-414-0461
Mailing Address - Fax:
Practice Address - Street 1:821 EAST SYCAMORE STREET
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3427
Practice Address - Country:US
Practice Address - Phone:704-735-3117
Practice Address - Fax:704-735-1107
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPENDING1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice