Provider Demographics
NPI:1013053354
Name:HERBER, HOBERT EDMUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOBERT
Middle Name:EDMUND
Last Name:HERBER
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 1:24 EL VIENTO
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2852
Mailing Address - Country:US
Mailing Address - Phone:805-773-0401
Mailing Address - Fax:805-489-2619
Practice Address - Street 1:901 OAK PARK BLVD # 201
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3216
Practice Address - Country:US
Practice Address - Phone:805-489-5545
Practice Address - Fax:805-489-2619
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice