Provider Demographics
NPI:1174570006
Name:HERRON, ROBERT D JR (DDS PA)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:HERRON
Suffix:JR
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:KS
Mailing Address - Zip Code:66725-0507
Mailing Address - Country:US
Mailing Address - Phone:620-429-1020
Mailing Address - Fax:620-429-3267
Practice Address - Street 1:806 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-1924
Practice Address - Country:US
Practice Address - Phone:620-429-1020
Practice Address - Fax:620-429-3267
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS66121223G0001X
MO20240475221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice