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NPI Code Detail

MEDICARE: DR. KELLY J. HERBS DMD

MEDICARE: DR. KELLY J. HERBS DMD
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
11223G0001XGeneral Practice Dentistry045807-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000493343002OTHERNYBLUE SHIELD
210033786OTHERNYCDPHP
3816875OTHERNYUNITED CONCORDIA

General Provider Information

NPI Number : 1487674024
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY J. HERBS DMD
Provider Business Mailing Address
First Line : 286 CHURCH ST
Second Line :
City : SARATOGA SPRINGS
State : NY
Zip : 12866-9208
Country : US
Telephone Number : 518-584-8150
Fax Number : 581-584-8751
Provider Business Practice Location Address
First Line : 286 CHURCH ST
Second Line :
City : SARATOGA SPRINGS
State : NY
Zip : 12866-9208
Country : US
Telephone Number : 518-584-8150
Fax Number : 581-584-8751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/08/2007

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