MEDICARE: DR. HOBERT EDMUND HERBER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	29292	CA

General Provider Information

NPI Number	:	1013053354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOBERT EDMUND HERBER D.D.S.

Provider Business Mailing Address
First Line	:	24 EL VIENTO
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-2852
Country	:	US
Telephone Number	:	805-773-0401
Fax Number	:	805-489-2619

Provider Business Practice Location Address
First Line	:	901 OAK PARK BLVD # 201
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3216
Country	:	US
Telephone Number	:	805-489-5545
Fax Number	:	805-489-2619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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