Healthcare Provider Details

I. General information

NPI: 1104847292
Provider Name (Legal Business Name): HERMAN STRATING D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ENON ST
BEVERLY MA
01915-1116
US

IV. Provider business mailing address

16 ENON ST
BEVERLY MA
01915-1116
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-6726
  • Fax: 978-922-6727
Mailing address:
  • Phone: 978-922-6726
  • Fax: 978-922-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number17559
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: