Healthcare Provider Details

I. General information

NPI: 1780673418
Provider Name (Legal Business Name): HERBERT L LIVINGSTON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N POINT BLVD SUITE#501
BALTIMORE MD
21224-3413
US

IV. Provider business mailing address

317 WILLOW OAK CIR
PIKESVILLE MD
21208-1375
US

V. Phone/Fax

Practice location:
  • Phone: 410-288-3000
  • Fax: 410-288-5439
Mailing address:
  • Phone: 410-415-0886
  • Fax: 410-415-0855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4495
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: