Provider Demographics
NPI:1629236948
Name:HERRINGTON, WILLIAM G (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:HERRINGTON
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 1:1515 HAZEL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2850
Mailing Address - Country:US
Mailing Address - Phone:417-358-4231
Mailing Address - Fax:417-358-9387
Practice Address - Street 1:1515 HAZEL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2850
Practice Address - Country:US
Practice Address - Phone:417-358-4231
Practice Address - Fax:417-358-9387
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0137381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO401704903Medicaid