MEDICARE: DR. JOSEPH A HERBST 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	1223E0200X	Endodontics	4819	MD

General Provider Information

NPI Number	:	1912900929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH A HERBST D.D.S.

Provider Business Mailing Address
First Line	:	13320 SHERWOOD FOREST DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1201
Country	:	US
Telephone Number	:	301-384-0849
Fax Number	:

Provider Business Practice Location Address
First Line	:	14333 LAUREL BOWIE RD
Second Line	:	STE 311
City	:	LAUREL
State	:	MD
Zip	:	20708-1183
Country	:	US
Telephone Number	:	301-604-5550
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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