Provider Demographics
NPI:1003506700
Name:HERRING DDS PLLC
Entity type:Organization
Organization Name:HERRING DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-267-2294
Mailing Address - Street 1:4203 E INDIAN SCHOOL RD STE 220
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5344
Mailing Address - Country:US
Mailing Address - Phone:870-267-2294
Mailing Address - Fax:
Practice Address - Street 1:4203 E INDIAN SCHOOL RD STE 220
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5344
Practice Address - Country:US
Practice Address - Phone:870-267-2294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment