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General NPI Number Information
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NPI Number | 1487790507
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Entity Type | Individual
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Provider Name | HERBERT IRVING BADER DDS
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 LONG POND RD STE 204
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City | PLYMOUTH
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State | MA
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Zip | 02360-2642
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Country | US
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Telephone | 508-830-3339
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Fax | 508-830-1976
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Provider Business Mailing Address
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Address Line | 48 JAMES CIR
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City | MASHPEE
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State | MA
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Zip | 02649-4913
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Country | US
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Telephone | 508-830-3339
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Fax | 508-830-1976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 9924
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License Number State | MA
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