Provider Demographics
NPI:1508206301
Name:ROBERT D. HERRON JR. DDS PA
Entity Type:Organization
Organization Name:ROBERT D. HERRON JR. DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-429-1020
Mailing Address - Street 1:806 E MAPLE ST
Mailing Address - Street 2:PO BOX 507
Mailing Address - City:COLUMBUS
Mailing Address - State:KS
Mailing Address - Zip Code:66725-1924
Mailing Address - Country:US
Mailing Address - Phone:620-429-1020
Mailing Address - Fax:620-429-3267
Practice Address - Street 1:806 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-1924
Practice Address - Country:US
Practice Address - Phone:620-429-1020
Practice Address - Fax:620-429-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty