MEDICARE: GREGORY HERMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	048745-1	NY

General Provider Information

NPI Number	:	1285797159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY HERMAN DMD

Provider Business Mailing Address
First Line	:	124 NORTHERN LIGHTS DR
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-4108
Country	:	US
Telephone Number	:	315-455-2411
Fax Number	:	315-455-1899

Provider Business Practice Location Address
First Line	:	124 NORTHERN LIGHTS DR
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-4108
Country	:	US
Telephone Number	:	315-455-2411
Fax Number	:	315-455-1899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	03/21/2012

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