Individual provider Active NPI

Paul Sandford Herrin, D.D.S.

  • Dentist
  • Florissant, MO
National Provider Identifier
1578624086
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
13943 Issued in MO
Practice address
395 Derhake Rd
Florissant, MO 63031-7717
Phone
(314) 921-0070
Fax
(314) 921-7506
NPI assigned
Dec 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 13943 MO Primary

Addresses

Primary practice location

395 Derhake Rd
Florissant, MO 63031-7717

Mailing address

395 Derhake Rd
Florissant, MO 63031-7717
Phone (314) 921-0070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150424002061 MO Order and Referring Only - DentistPractitioner - Dentist 9436478484

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13943MOMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578624086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 DERHAKE RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630317717",
            "telephone_number": "314-921-0070",
            "fax_number": "314-921-7506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 DERHAKE RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630317717",
            "telephone_number": "314-921-0070",
            "fax_number": "314-921-7506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRIN",
        "first_name": "PAUL",
        "middle_name": "SANDFORD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "13943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florissant, MO

Sources for this page

Verify at the official NPI Registry.