Provider Demographics
NPI:1659499242
Name:HERBERT, JENNIFER C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
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 1:79 SCRIPPS DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-565-2570
Mailing Address - Fax:916-565-2575
Practice Address - Street 1:79 SCRIPPS DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-565-2570
Practice Address - Fax:916-565-2575
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice