Provider Demographics
NPI:1750454088
Name:HERBERGER, THOMAS ALBAN (DDS, CERT)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALBAN
Last Name:HERBERGER
Suffix:
Gender:M
Credentials:DDS, CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5124
Mailing Address - Country:US
Mailing Address - Phone:440-323-5488
Mailing Address - Fax:
Practice Address - Street 1:319 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5124
Practice Address - Country:US
Practice Address - Phone:440-323-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics