Healthcare Provider Details

I. General information

NPI: 1912900929
Provider Name (Legal Business Name): JOSEPH A HERBST D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14333 LAUREL BOWIE RD STE 311
LAUREL MD
20708-1183
US

IV. Provider business mailing address

13320 SHERWOOD FOREST DR
SILVER SPRING MD
20904-1201
US

V. Phone/Fax

Practice location:
  • Phone: 301-604-5550
  • Fax:
Mailing address:
  • Phone: 301-384-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4819
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: