Provider Demographics
NPI:1225222920
Name:JAMES P. HERBERT, D.M.D., P.A.
Entity Type:Organization
Organization Name:JAMES P. HERBERT, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-782-0670
Mailing Address - Street 1:22 STRAWBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5961
Mailing Address - Country:US
Mailing Address - Phone:207-782-0670
Mailing Address - Fax:207-782-5558
Practice Address - Street 1:22 STRAWBERRY AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5961
Practice Address - Country:US
Practice Address - Phone:207-782-0670
Practice Address - Fax:207-782-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN 40301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty