Provider Demographics
NPI:1174360903
Name:HERRERO, ISABELLA MALONEY (DMD)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:MALONEY
Last Name:HERRERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 ATLANTA RD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3650
Mailing Address - Country:US
Mailing Address - Phone:678-203-3463
Mailing Address - Fax:
Practice Address - Street 1:2995 ATLANTA RD SE STE 200
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3650
Practice Address - Country:US
Practice Address - Phone:678-203-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist