Individual
DR. NILES WALTER HERROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
777 N 500 W, SUITE 102, PROVO, UT 84601-1541
(801) 375-4707
Mailing address
871 OSMOND LN, PROVO, UT 84604-5264
(801) 225-7229
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1321679924
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20859
IHC
—
Enumeration date
10/23/2006
Last updated
07/09/2007
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