Provider Demographics
NPI:1730178195
Name:HERRERA, JOE M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:M
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WASHINGTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101
Mailing Address - Country:US
Mailing Address - Phone:913-362-8868
Mailing Address - Fax:913-362-1780
Practice Address - Street 1:701 WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101
Practice Address - Country:US
Practice Address - Phone:913-362-8868
Practice Address - Fax:913-362-1780
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100224130-AMedicaid
KS100224130AMedicaid
MO15284016OtherBLUE CROSS BLUE SHIELD OF KC