Healthcare Provider Details

I. General information

NPI: 1871740340
Provider Name (Legal Business Name): MICHAEL SCOTT HERMSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N 90TH ST
OMAHA NE
68114-2821
US

IV. Provider business mailing address

615 N 90TH ST
OMAHA NE
68114-2821
US

V. Phone/Fax

Practice location:
  • Phone: 402-393-5050
  • Fax: 402-393-3401
Mailing address:
  • Phone: 402-393-5050
  • Fax: 402-393-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6510
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: