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General NPI Number Information
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NPI Number | 1629584586
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Entity Type | Organization
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Legal Business Name | HERRIN CPDS PC
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1571 PHOENIX BLVD STE 8
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5536
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Country | US
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Telephone | 844-682-4737
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Fax | 404-521-4044
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Provider Business Mailing Address
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Address Line | PO BOX 370160
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City | DECATUR
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State | GA
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Zip | 30037-0160
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Country | US
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Telephone | 404-403-4567
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Fax | 404-521-4044
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DR. MARCUS QURAN POLK
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Credential | MD
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Telephone | 404-403-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN013021
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN014898
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN014185
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License Number State | GA
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