Provider Demographics
NPI:1902259377
Name:ANTUAN L. HERRIOTT, DMD, PA
Entity Type:Organization
Organization Name:ANTUAN L. HERRIOTT, DMD, PA
Other - Org Name:LINCOLNTON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTUAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-414-0461
Mailing Address - Street 1:821 E SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3427
Mailing Address - Country:US
Mailing Address - Phone:704-735-3117
Mailing Address - Fax:704-735-1107
Practice Address - Street 1:821 E SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3427
Practice Address - Country:US
Practice Address - Phone:704-735-3117
Practice Address - Fax:704-735-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910047Medicaid