Provider Demographics
NPI:1760411128
Name:HERBERT, DENLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENLY
Middle Name:
Last Name:HERBERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4403
Mailing Address - Country:US
Mailing Address - Phone:650-556-1367
Mailing Address - Fax:650-556-1368
Practice Address - Street 1:707 PARNASSUS AVE
Practice Address - Street 2:BOX 0752
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2210
Practice Address - Country:US
Practice Address - Phone:415-476-4946
Practice Address - Fax:415-242-0108
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD29293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD29293OtherSTATE LICENSE