Provider Demographics
NPI:1730267667
Name:HERRERA, ROBERT M (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
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 1:3841 OKEMOS RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3635
Mailing Address - Country:US
Mailing Address - Phone:517-347-5030
Mailing Address - Fax:517-347-0595
Practice Address - Street 1:3841 OKEMOS RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3635
Practice Address - Country:US
Practice Address - Phone:517-347-5030
Practice Address - Fax:517-347-0595
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010169401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice