Provider Demographics
NPI:1366568362
Name:PAZ, HERONIMO (DDS)
Entity type:Individual
Prefix:DR
First Name:HERONIMO
Middle Name:
Last Name:PAZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:H
Other - Middle Name:JERRY
Other - Last Name:PAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:507 N STATE HIGHWAY 47
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1611
Mailing Address - Country:US
Mailing Address - Phone:636-456-2454
Mailing Address - Fax:636-456-1511
Practice Address - Street 1:507 N STATE HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1611
Practice Address - Country:US
Practice Address - Phone:636-456-2454
Practice Address - Fax:636-456-1511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0135141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice