Provider Demographics
NPI:1992756951
Name:HERBST, HEIDI A (DDS)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:HERBST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21475 RIDGETOP CIRCLE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8504
Mailing Address - Country:US
Mailing Address - Phone:703-444-3710
Mailing Address - Fax:703-444-8607
Practice Address - Street 1:21475 RIDGETOP CIRCLE SUITE 200
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8504
Practice Address - Country:US
Practice Address - Phone:703-444-3710
Practice Address - Fax:703-444-8607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5876122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0012899Medicaid