Healthcare Provider Details

I. General information

NPI: 1205996121
Provider Name (Legal Business Name): THOMAS EDWARD HERREMANS DDS MPH MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 SAWKAW NE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

4353 SAWKAW NE
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-363-9821
  • Fax: 616-365-9206
Mailing address:
  • Phone: 616-363-9821
  • Fax: 616-365-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901017050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: