Provider Demographics
NPI:1437224227
Name:HERBERT, JENNIFER ANN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:HERBERT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S 7TH ST
Mailing Address - Street 2:SUITE 133
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2310
Mailing Address - Country:US
Mailing Address - Phone:612-332-0592
Mailing Address - Fax:612-332-8188
Practice Address - Street 1:109 S 7TH ST
Practice Address - Street 2:SUITE 133
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2310
Practice Address - Country:US
Practice Address - Phone:612-332-0592
Practice Address - Fax:612-332-8188
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND112541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice