Provider Demographics
NPI:1639128770
Name:HERRE, CRAIG WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:HERRE
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 1:11435 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2932
Mailing Address - Country:US
Mailing Address - Phone:913-338-2233
Mailing Address - Fax:913-491-8649
Practice Address - Street 1:11201 NALL AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1669
Practice Address - Country:US
Practice Address - Phone:913-491-4466
Practice Address - Fax:913-469-1797
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist