Provider Demographics
NPI:1487661641
Name:HERRING, KRISTIN WEST (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:WEST
Last Name:HERRING
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 1:1930 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-5592
Mailing Address - Country:US
Mailing Address - Phone:828-294-1044
Mailing Address - Fax:
Practice Address - Street 1:1930 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5592
Practice Address - Country:US
Practice Address - Phone:828-294-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904873Medicaid
9028JOtherBCBS IND. #
NCDENTAL LICENCEOther8041