Provider Demographics
NPI:1972760965
Name:HERRON, ELIZABETH C (DDS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:HERRON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 VOLTAIRE DR
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-4478
Mailing Address - Country:US
Mailing Address - Phone:818-887-2456
Mailing Address - Fax:
Practice Address - Street 1:6400 CANOGA AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2425
Practice Address - Country:US
Practice Address - Phone:818-887-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist