Healthcare Provider Details

I. General information

NPI: 1033273230
Provider Name (Legal Business Name): ALVEN LEE HERSTIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 E MAIN ST SUITE B
COLUMBUS OH
43213-2436
US

IV. Provider business mailing address

5180 E MAIN ST SUITE B
COLUMBUS OH
43213-2436
US

V. Phone/Fax

Practice location:
  • Phone: 614-864-2140
  • Fax:
Mailing address:
  • Phone: 614-864-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number13496
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: