Provider Demographics
NPI:1255547345
Name:HERRERA, CASEY MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:MARIE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 EL CAMINO REAL STE 270
Mailing Address - Street 2:
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3866
Mailing Address - Country:US
Mailing Address - Phone:650-556-9999
Mailing Address - Fax:650-556-9990
Practice Address - Street 1:3301 EL CAMINO REAL STE 270
Practice Address - Street 2:
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3866
Practice Address - Country:US
Practice Address - Phone:650-556-9999
Practice Address - Fax:650-556-9990
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA367671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics