Provider Demographics
NPI:1902112527
Name:HER-ELLISON, ME (DDS)
Entity Type:Individual
Prefix:
First Name:ME
Middle Name:
Last Name:HER-ELLISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ME
Other - Middle Name:
Other - Last Name:HER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DD,S,
Mailing Address - Street 1:1222 N DOUTY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3449
Mailing Address - Country:US
Mailing Address - Phone:559-582-2827
Mailing Address - Fax:
Practice Address - Street 1:1222 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3449
Practice Address - Country:US
Practice Address - Phone:559-582-2827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist