Provider Demographics
NPI:1881422863
Name:HERNDON DDS INC
Entity type:Organization
Organization Name:HERNDON DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-867-3712
Mailing Address - Street 1:14375 SARATOGA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5978
Mailing Address - Country:US
Mailing Address - Phone:408-867-3712
Mailing Address - Fax:
Practice Address - Street 1:14375 SARATOGA AVE STE 100
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5978
Practice Address - Country:US
Practice Address - Phone:408-867-3712
Practice Address - Fax:408-867-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty