Healthcare Provider Details

I. General information

NPI: 1194718031
Provider Name (Legal Business Name): JOHN R HERRIN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 S RIVER RD
BEDFORD NH
03110-6941
US

IV. Provider business mailing address

170 S RIVER RD
BEDFORD NH
03110-6941
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-8787
  • Fax: 603-624-7944
Mailing address:
  • Phone: 603-624-8787
  • Fax: 603-624-7944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2063
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: