MEDICARE: DOUGLAS HERBERT, D.D.S., LTD.

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	0401008867	VA

General Provider Information

NPI Number	:	1720124977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS HERBERT, D.D.S., LTD.

Provider Business Mailing Address
First Line	:	2 CARDINAL PARK DR SE
Second Line	:	SUITE 201A
City	:	LEESBURG
State	:	VA
Zip	:	20175-4448
Country	:	US
Telephone Number	:	703-777-8777
Fax Number	:	703-777-6901

Provider Business Practice Location Address
First Line	:	2 CARDINAL PARK DR SE
Second Line	:	SUITE 201A
City	:	LEESBURG
State	:	VA
Zip	:	20175-4448
Country	:	US
Telephone Number	:	703-777-8777
Fax Number	:	703-777-6901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AMANDA BROWN
Credential	:	D.D.S.
Telephone Number	:	703-777-8777

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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