Provider Demographics
NPI:1720485675
Name:HERBERT, AMY KRISTINA (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTINA
Last Name:HERBERT
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 1:360 RIVERSIDE DR APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2750
Mailing Address - Country:US
Mailing Address - Phone:917-273-8799
Mailing Address - Fax:
Practice Address - Street 1:93-20A ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:718-838-9823
Practice Address - Fax:718-247-5727
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025426001223P0221X
NY0575541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry