Provider Demographics
NPI:1487790507
Name:BADER, HERBERT IRVING (DDS)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:IRVING
Last Name:BADER
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 1:48 JAMES CIR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-4913
Mailing Address - Country:US
Mailing Address - Phone:508-830-3339
Mailing Address - Fax:508-830-1976
Practice Address - Street 1:110 LONG POND RD STE 204
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2642
Practice Address - Country:US
Practice Address - Phone:508-830-3339
Practice Address - Fax:508-830-1976
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA99241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics