Healthcare Provider Details

I. General information

NPI: 1912114778
Provider Name (Legal Business Name): ANTHONY WILLIAM HERRON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 BURNET RD
AUSTIN TX
78756
US

IV. Provider business mailing address

9303 SCOTTY OAKS
HELOTES TX
78023
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-1010
  • Fax: 512-454-5050
Mailing address:
  • Phone: 210-372-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21006
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: