MEDICARE: DR. JAMES R. HERBST II D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15914	TX

General Provider Information

NPI Number	:	1407858293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R. HERBST II D.D.S.

Provider Business Mailing Address
First Line	:	2401 FOUNTAIN VIEW DR
Second Line	:	SUITE 106
City	:	HOUSTON
State	:	TX
Zip	:	77057-4827
Country	:	US
Telephone Number	:	713-266-2265
Fax Number	:	173-266-1560

Provider Business Practice Location Address
First Line	:	2401 FOUNTAIN VIEW DR
Second Line	:	SUITE 106
City	:	HOUSTON
State	:	TX
Zip	:	77057-4827
Country	:	US
Telephone Number	:	713-266-2265
Fax Number	:	173-266-1560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	04/09/2024

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