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Individual
DR. KELLY J. HERBS
Active
Individual
DR. KELLY J. HERBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
045807-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000493343002
BLUE SHIELD
NY
01
—
10033786
CDPHP
NY
01
—
816875
UNITED CONCORDIA
NY
Enumeration date
07/19/2006
Last updated
07/08/2007
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