Healthcare Provider Details

I. General information

NPI: 1972721868
Provider Name (Legal Business Name): DAVID MYLES HERMAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 NEWMAN SPRINGS RD SUITE A
LINCROFT NJ
07738-1744
US

IV. Provider business mailing address

654 NEWMAN SPRINGS RD SUITE A
LINCROFT NJ
07738-1744
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-4444
  • Fax: 732-747-4003
Mailing address:
  • Phone: 732-747-4444
  • Fax: 732-747-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22465
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID HERMAN
Title or Position: OWNER
Credential: D.M.D.
Phone: 732-747-4444