| Doctor Name: | MR. EUGENIO G HERBOSA |
| NPI Number: | 1063593838 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DMD MMSC |
| License Number: | 15229 |
| Business Practice Address: | 12818 Tesson Ferry Road Suite 204 St Louis, MO - 63128 |
| Business Phone Number: | 3148420020 |
| Business Fax Number: | 3148421590 |
| Mailing Address: | 1034 S Brentwood, Suite 1010 ST LOUIS |
| State: | MO |
| Postal Code: | 63128 |
| Phone Number: | 3147211010 |
| Fax Number: | 3147215276 |
| NPI Enumeration Date: | 10/18/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204E00000X |
| License Number: | 15229 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Oral & Maxillofacial Surgery |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |