Healthcare Provider Details

I. General information

NPI: 1891904843
Provider Name (Legal Business Name): ALVEN L. HERSTIG, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
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: DR. ALVEN LEE HERSTIG
Title or Position: PRESIDENT
Credential: DDS
Phone: 614-864-2140