Provider Demographics
NPI:1063768950
Name:HEROD, BRIAN TAYLOR (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TAYLOR
Last Name:HEROD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9028 MOUNT EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7829
Mailing Address - Country:US
Mailing Address - Phone:804-305-6830
Mailing Address - Fax:
Practice Address - Street 1:1009 CROWDER DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4237
Practice Address - Country:US
Practice Address - Phone:804-794-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-28
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014136201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice