Healthcare Provider Details

I. General information

NPI: 1811337538
Provider Name (Legal Business Name): HERMAN FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 S QUAIL RUN RD
VINCENNES IN
47591-6884
US

IV. Provider business mailing address

608 S QUAIL RUN RD
VINCENNES IN
47591-6884
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-1572
  • Fax: 812-882-4450
Mailing address:
  • Phone: 812-882-1572
  • Fax: 812-882-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12010409A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC L HERMAN
Title or Position: OWNER
Credential: DDS
Phone: 812-882-1572