Healthcare Provider Details

I. General information

NPI: 1437183696
Provider Name (Legal Business Name): ELDER HERAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 VICTOR AVE
HESPERIA CA
92345-4172
US

IV. Provider business mailing address

7550 VICTOR AVE
HESPERIA CA
92345-4172
US

V. Phone/Fax

Practice location:
  • Phone: 562-773-7565
  • Fax: 562-773-7565
Mailing address:
  • Phone: 562-773-7565
  • Fax: 562-773-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: