Individual
TIMOTHY M HERBST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
402 W JEFFERSON ST, KIRKSVILLE, MO 63501-3407
(660) 665-2741
(660) 665-3109
Mailing address
1416 CROWN DRIVE, KIRKSVILLE, MO 63501-2548
(660) 627-5757
(660) 627-5802
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2001012903
MO
1223D0001X
Public Health Dentistry
Primary
2001012903
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
408444107
—
MO
Enumeration date
12/20/2005
Last updated
11/06/2012
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