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General NPI Number Information
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NPI Number | 1689745457
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Entity Type | Individual
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Provider Name | PAUL DANA HERER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 195 S RAND RD SUITE110
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City | LAKE ZURICH
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State | IL
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Zip | 60047-2205
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Country | US
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Telephone | 847-726-0300
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Fax | 847-726-3799
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Provider Business Mailing Address
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Address Line | 195 SOUTH RAND ROAD SUITE 110
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City | LAKE ZURICH
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State | IL
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Zip | 66047
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Country | US
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Telephone | 847-726-0300
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Fax | 847-726-3799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019014868
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License Number State | IL
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