MEDICARE: DR. BRENT HERRING 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	D011024	AZ

General Provider Information

NPI Number	:	1457805376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT HERRING DDS

Provider Business Mailing Address
First Line	:	4203 E INDIAN SCHOOL RD STE 220
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5344
Country	:	US
Telephone Number	:	602-955-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	4203 E INDIAN SCHOOL RD STE 220
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5344
Country	:	US
Telephone Number	:	602-955-1780
Fax Number	:

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

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	05/14/2024

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