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General NPI Number Information
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NPI Number | 1821786831
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Entity Type | Organization
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Legal Business Name | HERRON FAMILY DENTAL INC
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 7203 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60636-3653
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Country | US
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Telephone | 773-476-5335
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Fax |
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Provider Business Mailing Address
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Address Line | 7203 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60636-3653
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Country | US
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Telephone | 773-329-3303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEVERE HERRON
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Credential | DDS
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Telephone | 773-476-5335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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