MEDICARE: HERALD FAMILY DENISTRY PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1376778456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERALD FAMILY DENISTRY PLLC

Provider Business Mailing Address
First Line	:	725 ALEXANDRIA PIKE STE 100
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2168
Country	:	US
Telephone Number	:	859-781-0221
Fax Number	:	859-781-0288

Provider Business Practice Location Address
First Line	:	725 ALEXANDRIA PIKE STE 100
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2168
Country	:	US
Telephone Number	:	859-781-0221
Fax Number	:	859-781-0288

Authorized Official
Title or Position	:	D.M.D.
Name	:	DR. MICHAEL JOSEPH HERALD II
Credential	:	D.M.D.
Telephone Number	:	859-781-0221

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	06/14/2019

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