Provider Demographics
NPI:1285789495
Name:HERBST, ERICH (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICH
Middle Name:
Last Name:HERBST
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 1:1203 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1805
Mailing Address - Country:US
Mailing Address - Phone:608-356-2112
Mailing Address - Fax:608-356-0919
Practice Address - Street 1:1203 8TH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1805
Practice Address - Country:US
Practice Address - Phone:608-356-2112
Practice Address - Fax:608-356-0919
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3876-0151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1901OtherDEANCARE PROVIDER NUMBER
1008608OtherPHYSICIANS PLUS PROV. #
WI33677900Medicaid
1008608OtherPHYSICIANS PLUS PROV. #
WIT95289Medicare ID - Type Unspecified