MEDICARE: DR. JOE M. 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	1223G0001X	General Practice Dentistry	6532	KS

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	15284016	OTHER	MO	BLUE CROSS BLUE SHIELD OF KC

General Provider Information

NPI Number	:	1730178195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE M. HERRERA DDS

Provider Business Mailing Address
First Line	:	701 WASHINGTON BLVD.
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66101
Country	:	US
Telephone Number	:	913-362-8868
Fax Number	:	913-362-1780

Provider Business Practice Location Address
First Line	:	701 WASHINGTON BLVD.
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66101
Country	:	US
Telephone Number	:	913-362-8868
Fax Number	:	913-362-1780

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	09/16/2009

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