Provider Demographics
NPI:1235252933
Name:HEROD, AUDREY ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ANN
Last Name:HEROD
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 1:170 SOUTH RIVER ROAD
Mailing Address - Street 2:BUILDING II UNIT #4
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-424-6131
Mailing Address - Fax:603-424-3620
Practice Address - Street 1:170 SOUTH RIVER ROAD
Practice Address - Street 2:BUILDING II UNIT #4
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-424-6131
Practice Address - Fax:603-424-3620
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist