Provider Demographics
NPI:1881672459
Name:HERRELL, JEFFREY TOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TOD
Last Name:HERRELL
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 1:174 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4423
Mailing Address - Country:US
Mailing Address - Phone:301-695-9446
Mailing Address - Fax:301-695-6170
Practice Address - Street 1:174 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE # 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4423
Practice Address - Country:US
Practice Address - Phone:301-695-9446
Practice Address - Fax:301-695-6170
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD96221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice