Provider Demographics
NPI:1740991652
Name:HERBECK DENTAL LLC
Entity type:Organization
Organization Name:HERBECK DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:HERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-459-0009
Mailing Address - Street 1:1355 N COURTENAY PKWY STE K
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4401
Mailing Address - Country:US
Mailing Address - Phone:321-459-0009
Mailing Address - Fax:
Practice Address - Street 1:1355 N COURTENAY PKWY STE K
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4401
Practice Address - Country:US
Practice Address - Phone:321-459-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental