Provider Demographics
NPI:1487674024
Name:HERBS, KELLY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:HERBS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9208
Mailing Address - Country:US
Mailing Address - Phone:518-584-8150
Mailing Address - Fax:581-584-8751
Practice Address - Street 1:286 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9208
Practice Address - Country:US
Practice Address - Phone:518-584-8150
Practice Address - Fax:581-584-8751
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045807-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000493343002OtherBLUE SHIELD
NY10033786OtherCDPHP
NY816875OtherUNITED CONCORDIA