Provider Demographics
NPI:1629300272
Name:HARBERT, HENRY LUCIEN (ENDODONTIST, DMD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:LUCIEN
Last Name:HARBERT
Suffix:
Gender:M
Credentials:ENDODONTIST, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 MURPHY RD.
Mailing Address - Street 2:STE 204
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-245-0984
Mailing Address - Fax:541-245-9018
Practice Address - Street 1:691 MURPHY RD.
Practice Address - Street 2:STE 204
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-245-0984
Practice Address - Fax:541-245-9018
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD44291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics