Healthcare Provider Details

I. General information

NPI: 1225214547
Provider Name (Legal Business Name): MICHAEL C HERREN DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W 5TH ST
LONDON KY
40741-1612
US

IV. Provider business mailing address

1221 W 5TH ST
LONDON KY
40741-1612
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-4744
  • Fax:
Mailing address:
  • Phone: 606-864-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7414
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL C HERREN
Title or Position: OWNER
Credential: DMD
Phone: 606-864-4744