Healthcare Provider Details

I. General information

NPI: 1356586168
Provider Name (Legal Business Name): DR. SIDNEY H. HERR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 JEFFCO BLVD
ARNOLD MO
63010-1410
US

IV. Provider business mailing address

937 JEFFCO BLVD
ARNOLD MO
63010-1410
US

V. Phone/Fax

Practice location:
  • Phone: 636-296-6332
  • Fax: 636-287-6335
Mailing address:
  • Phone: 636-296-6332
  • Fax: 636-287-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateMO

VIII. Authorized Official

Name: DR. SIDNEY H HERR
Title or Position: ORTHODONTIST
Credential: DDS MS PC
Phone: 636-296-6332