Healthcare Provider Details

I. General information

NPI: 1689774200
Provider Name (Legal Business Name): BRENDA PHILLIPS HERRMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 01/18/2020
Certification Date: 01/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 CHESTNUT ST
SENECA MO
64865-9261
US

IV. Provider business mailing address

4752 E TRAILWOOD WAY
SPRINGFIELD MO
65809-4318
US

V. Phone/Fax

Practice location:
  • Phone: 417-776-2291
  • Fax: 417-776-2292
Mailing address:
  • Phone: 417-838-9199
  • Fax: 888-513-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE015183
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: