Provider Demographics
NPI:1942730171
Name:HERROD, ROBERT JOSEPH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:HERROD
Suffix:
Gender:M
Credentials:DMD, MS
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Other - Credentials:
Mailing Address - Street 1:1 SW 129TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1718
Mailing Address - Country:US
Mailing Address - Phone:954-432-2080
Mailing Address - Fax:954-432-5560
Practice Address - Street 1:1 SW 129TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1718
Practice Address - Country:US
Practice Address - Phone:954-432-2080
Practice Address - Fax:954-432-5560
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026776001223S0112X
NJ06977204E00000X
AR45251223S0112X, 204E00000X
FLDN26035204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery