Healthcare Provider Details

I. General information

NPI: 1801716634
Provider Name (Legal Business Name): MARIAH HEROLD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13367 ISLE DR STE 1
BAXTER MN
56425-2224
US

IV. Provider business mailing address

8590 FIR ST
GREENFIELD MN
55373
US

V. Phone/Fax

Practice location:
  • Phone: 320-360-6904
  • Fax:
Mailing address:
  • Phone: 320-360-6904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15529
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: