Healthcare Provider Details

I. General information

NPI: 1760624233
Provider Name (Legal Business Name): DOUGLAS M HERRERA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 SW 7TH ST STE 2008
MIAMI FL
33130-2961
US

IV. Provider business mailing address

175 SW 7TH ST STE 2008
MIAMI FL
33130-2961
US

V. Phone/Fax

Practice location:
  • Phone: 305-300-6485
  • Fax:
Mailing address:
  • Phone: 650-996-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN18485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: