Healthcare Provider Details

I. General information

NPI: 1467817189
Provider Name (Legal Business Name): SENECA FAMILY DENTAL BRENDA HERRMAN, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 CHESTNUT ST
SENECA MO
64865-9261
US

IV. Provider business mailing address

1406 CHESTNUT ST PO BOX 455
SENECA MO
64865-9261
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number015183
License Number StateMO

VIII. Authorized Official

Name: DR. BRENDA HERRMAN
Title or Position: OWNER
Credential: DDS
Phone: 417-838-9199