Healthcare Provider Details

I. General information

NPI: 1588667463
Provider Name (Legal Business Name): DRS. HERMAN AND MACK P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 7TH ST NE
DEVILS LAKE ND
58301-2719
US

IV. Provider business mailing address

1003 7TH ST NE
DEVILS LAKE ND
58301-2719
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-8191
  • Fax: 701-662-5757
Mailing address:
  • Phone: 701-662-8191
  • Fax: 701-662-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1654
License Number StateND

VIII. Authorized Official

Name: DR. ROLLIN D HERMAN
Title or Position: PRES
Credential: DDS
Phone: 701-662-8191