Provider Demographics
NPI:1659407658
Name:HERNCO HEALTHCARE PC
Entity Type:Organization
Organization Name:HERNCO HEALTHCARE PC
Other - Org Name:HERNDON FAMILY DENTISTIRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-527-7070
Mailing Address - Street 1:425 W TRUMAN PL
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-3209
Mailing Address - Country:US
Mailing Address - Phone:405-527-7070
Mailing Address - Fax:405-527-3046
Practice Address - Street 1:425 W TRUMAN PL
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-3209
Practice Address - Country:US
Practice Address - Phone:405-527-7070
Practice Address - Fax:405-527-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty