Provider Demographics
NPI:1962787853
Name:HERNDON FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:HERNDON FAMILY DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MEER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-657-0000
Mailing Address - Street 1:131 ELDEN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4835
Mailing Address - Country:US
Mailing Address - Phone:703-657-0000
Mailing Address - Fax:703-657-0958
Practice Address - Street 1:131 ELDEN ST STE 100
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-657-0000
Practice Address - Fax:703-657-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412049261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental