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NPI Code Detail

MEDICARE: MR. DONALD L HERNDON DMD

MEDICARE:  MR. DONALD L HERNDON  DMD
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
11223G0001XGeneral Practice Dentistry2581SC

General Provider Information

NPI Number : 1457488579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD L HERNDON DMD
Provider Business Mailing Address
First Line : 1376A CLEVELAND ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2435
Country : US
Telephone Number : 864-250-1500
Fax Number : 864-250-1502
Provider Business Practice Location Address
First Line : 1376A CLEVELAND ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2435
Country : US
Telephone Number : 864-250-1500
Fax Number : 864-250-1502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 07/08/2007

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Directions to “ MR. DONALD L HERNDON DMD” Practice Location

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