MEDICARE: HERNDON DDS INC

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	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1881422863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERNDON DDS INC

Provider Business Mailing Address
First Line	:	14375 SARATOGA AVE STE 100
Second Line	:
City	:	SARATOGA
State	:	CA
Zip	:	95070-5978
Country	:	US
Telephone Number	:	408-867-3712
Fax Number	:

Provider Business Practice Location Address
First Line	:	14375 SARATOGA AVE STE 100
Second Line	:
City	:	SARATOGA
State	:	CA
Zip	:	95070-5978
Country	:	US
Telephone Number	:	408-867-3712
Fax Number	:	408-867-2653

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIE HERNDON
Credential	:	DDS
Telephone Number	:	408-867-3712

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	08/02/2024

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