MEDICARE: DR. EVELYN LIMCANGCO HERRERA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN11461	FL

General Provider Information

NPI Number	:	1063529113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVELYN LIMCANGCO HERRERA DMD

Provider Business Mailing Address
First Line	:	2292 MAYPORT RD
Second Line	:	SUITE #17
City	:	JACKSONVILLE
State	:	FL
Zip	:	32233
Country	:	US
Telephone Number	:	904-249-4269
Fax Number	:	904-249-4269

Provider Business Practice Location Address
First Line	:	2292 MAYPORT RD
Second Line	:	SUITE #17
City	:	JACKSONVILLE
State	:	FL
Zip	:	32233
Country	:	US
Telephone Number	:	904-249-4269
Fax Number	:	904-249-4269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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