Provider Demographics
NPI:1013134386
Name:ROD, HERBERT DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:DAVID
Last Name:ROD
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 1:100 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8411
Mailing Address - Country:US
Mailing Address - Phone:413-443-4024
Mailing Address - Fax:
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:DEPARTMENT OF DENTISTRY
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2781
Practice Address - Fax:413-395-7922
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist