MEDICARE: DR. MARIA DE JESUS HERRERA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	041976	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063498046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA DE JESUS HERRERA DDS

Provider Business Mailing Address
First Line	:	3753 91ST ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7901
Country	:	US
Telephone Number	:	718-205-4377
Fax Number	:	718-205-8605

Provider Business Practice Location Address
First Line	:	3753 91ST ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7901
Country	:	US
Telephone Number	:	718-205-4377
Fax Number	:	718-205-8605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	12/14/2012

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