Healthcare Provider Details

I. General information

NPI: 1518575810
Provider Name (Legal Business Name): ROBERT SAMUEL HERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S MAIN ST STE 102
ROMEO MI
48065-5233
US

IV. Provider business mailing address

586 WESTWOOD DR
BIRMINGHAM MI
48009-1130
US

V. Phone/Fax

Practice location:
  • Phone: 586-752-2273
  • Fax: 586-336-7632
Mailing address:
  • Phone: 248-302-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901600560
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: