Provider Demographics
NPI:1285629188
Name:HERZBERG, MATTHEW LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:HERZBERG
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 1:5003 BARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7710
Mailing Address - Country:US
Mailing Address - Phone:703-566-1406
Mailing Address - Fax:
Practice Address - Street 1:3283 E PERIMETER RD
Practice Address - Street 2:BHC NAF WASHINGTON
Practice Address - City:ANDREWS AFB
Practice Address - State:MD
Practice Address - Zip Code:20762-5011
Practice Address - Country:US
Practice Address - Phone:240-857-4177
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist