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General NPI Number Information
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NPI Number | 1649289414
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Entity Type | Organization
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Legal Business Name | HERIFORD AND HERIFORD, DDS, PC
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2003 MEADE PKWY
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City | SUFFOLK
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State | VA
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Zip | 23434-4259
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Country | US
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Telephone | 757-539-1492
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Fax | 757-539-3298
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Provider Business Mailing Address
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Address Line | 1434 LAKE MEADE DR
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City | SUFFOLK
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State | VA
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Zip | 23434-7444
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Country | US
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Telephone | 757-925-4879
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUSAN HERIFORD
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Credential | DDS
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Telephone | 757-539-1492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401006896
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401006717
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License Number State | VA
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