MEDICARE: MARVA JEAN HERRING DDS

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	122300000X	Dentist	DEN5001	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DEN5001	OTHER	DC	DEPT OF HEALTH BOARD OF DENTISTRY

General Provider Information

NPI Number	:	1568776664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVA JEAN HERRING DDS

Provider Business Mailing Address
First Line	:	1818 NEW YORK AVE NE
Second Line	:	SUITE #116
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1848
Country	:	US
Telephone Number	:	202-450-2344
Fax Number	:	202-450-2400

Provider Business Practice Location Address
First Line	:	1818 NEW YORK AVE NE
Second Line	:	SUITE # 116
City	:	WASHINGTON
State	:	DC
Zip	:	20002-1848
Country	:	US
Telephone Number	:	202-450-2344
Fax Number	:	202-450-2400

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

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	05/02/2017

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