MEDICARE: HERNCO HEALTHCARE PC

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	4722	OK

General Provider Information

NPI Number	:	1659407658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERNCO HEALTHCARE PC

Provider Business Mailing Address
First Line	:	425 W TRUMAN PL
Second Line	:
City	:	PURCELL
State	:	OK
Zip	:	73080-3209
Country	:	US
Telephone Number	:	405-527-7070
Fax Number	:	405-527-3046

Provider Business Practice Location Address
First Line	:	425 W TRUMAN PL
Second Line	:
City	:	PURCELL
State	:	OK
Zip	:	73080-3209
Country	:	US
Telephone Number	:	405-527-7070
Fax Number	:	405-527-3046

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES NOEL HERNDON
Credential	:	DDS
Telephone Number	:	405-527-7070

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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