Provider Demographics
NPI:1366759946
Name:HEREDIA, AMPARO ELENA (DDS)
Entity type:Individual
Prefix:DR
First Name:AMPARO
Middle Name:ELENA
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 FILLMORE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3403
Mailing Address - Country:US
Mailing Address - Phone:415-921-4132
Mailing Address - Fax:415-921-2817
Practice Address - Street 1:3210 FILLMORE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-3403
Practice Address - Country:US
Practice Address - Phone:415-921-4132
Practice Address - Fax:415-921-2817
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist