Provider Demographics
NPI:1003815614
Name:HERRON, GARY ROBERT II (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROBERT
Last Name:HERRON
Suffix:II
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 1:4821 ALEXANDER BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6820
Mailing Address - Country:US
Mailing Address - Phone:505-345-2100
Mailing Address - Fax:505-345-4600
Practice Address - Street 1:4821 ALEXANDER BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6820
Practice Address - Country:US
Practice Address - Phone:505-345-2100
Practice Address - Fax:505-345-4600
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD25681223G0001X
TX168411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice