Individual
SHANA K HERRING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
143 CANAL ST STE 400, SUITE #2, POOLER, GA 31322-6016
(912) 748-2303
Mailing address
143 CANAL ST STE 400, POOLER, GA 31322-6016
(912) 748-2303
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012328
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
623961158A
—
GA
01
—
9180195
DORAL
GA
Enumeration date
02/26/2006
Last updated
12/22/2016
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