Provider Demographics
NPI:1790969988
Name:HERNON, PHILIP MURPHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MURPHY
Last Name:HERNON
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 1:24863 W JAYNE AVE
Mailing Address - Street 2:PLEASANT VALLEY STATE PRISION
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210
Mailing Address - Country:US
Mailing Address - Phone:559-935-4900
Mailing Address - Fax:559-935-7021
Practice Address - Street 1:24863 W JAYNE AVE
Practice Address - Street 2:PLEASANT VALLEY STATE PRISION
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210
Practice Address - Country:US
Practice Address - Phone:559-935-4900
Practice Address - Fax:559-935-7021
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice