Provider Demographics
NPI:1518157452
Name:HERBST, DAVID LEE (DDS- DENTIST)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:HERBST
Suffix:
Gender:M
Credentials:DDS- DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S 43RD ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7706
Mailing Address - Country:US
Mailing Address - Phone:253-475-0234
Mailing Address - Fax:
Practice Address - Street 1:11026 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5738
Practice Address - Country:US
Practice Address - Phone:253-475-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist