Provider Demographics
NPI:1306085246
Name:MERCEDES J HERRERA, A DENTAL CORPORATION
Entity type:Organization
Organization Name:MERCEDES J HERRERA, A DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-342-9938
Mailing Address - Street 1:80545 US HIGHWAY 111
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-6532
Mailing Address - Country:US
Mailing Address - Phone:760-342-9938
Mailing Address - Fax:760-342-9964
Practice Address - Street 1:80545 US HIGHWAY 111
Practice Address - Street 2:SUITE # 3
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-6532
Practice Address - Country:US
Practice Address - Phone:760-342-9938
Practice Address - Fax:760-342-9967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty