Healthcare Provider Details

I. General information

NPI: 1861414336
Provider Name (Legal Business Name): DR. BARRY I HERBST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 HUNTER MILL RD SUITE 10
OAKTON VA
22124-1716
US

IV. Provider business mailing address

2915 HUNTER MILL RD SUITE 10
OAKTON VA
22124-1716
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-4300
  • Fax: 703-938-4433
Mailing address:
  • Phone: 703-938-4300
  • Fax: 703-938-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401004331
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: