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General NPI Number Information
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NPI Number | 1780673418
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Entity Type | Individual
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Provider Name | HERBERT L LIVINGSTON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/15/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1001 N POINT BLVD SUITE#501
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City | BALTIMORE
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State | MD
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Zip | 21224-3413
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Country | US
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Telephone | 410-288-3000
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Fax | 410-288-5439
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Provider Business Mailing Address
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Address Line | 317 WILLOW OAK CIR
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City | PIKESVILLE
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State | MD
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Zip | 21208-1375
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Country | US
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Telephone | 410-415-0886
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Fax | 410-415-0855
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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 | 4495
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License Number State | MD
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