Provider Demographics
NPI:1710984471
Name:HERRERO, MIGUEL IVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:IVAN
Last Name:HERRERO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BRAKENDALE PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77389-2025
Mailing Address - Country:US
Mailing Address - Phone:787-644-0694
Mailing Address - Fax:
Practice Address - Street 1:27 BRAKENDALE PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77389-2025
Practice Address - Country:US
Practice Address - Phone:787-644-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD-022821223G0001X
TX216101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice