Provider Demographics
NPI:1881185080
Name:HERBST, STEPHANIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:HERBST
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 1:4106 SHENANDOAH
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2019
Mailing Address - Country:US
Mailing Address - Phone:580-747-1913
Mailing Address - Fax:
Practice Address - Street 1:2411 HERITAGE TRL STE 4
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1604
Practice Address - Country:US
Practice Address - Phone:580-237-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist