Provider Demographics
NPI:1740347418
Name:HERBERT, MICHAEL DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
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 1:6032 PARADISE POINT DR
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2634
Mailing Address - Country:US
Mailing Address - Phone:305-254-6928
Mailing Address - Fax:305-271-3013
Practice Address - Street 1:12515 SW 88TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1870
Practice Address - Country:US
Practice Address - Phone:305-271-9711
Practice Address - Fax:305-271-3013
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist