Provider Demographics
NPI:1871840983
Name:HERRIN PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:HERRIN PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-215-5352
Mailing Address - Street 1:3020 ROSWELL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4996
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 ROSWELL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4996
Practice Address - Country:US
Practice Address - Phone:678-215-5352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty