Healthcare Provider Details

I. General information

NPI: 1689060808
Provider Name (Legal Business Name): BRANDYN HERMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 01/02/2023
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10587 DOUBLE R BLVD STE 100
RENO NV
89521-8966
US

IV. Provider business mailing address

10587 DOUBLE R BLVD STE 100
RENO NV
89521-8966
US

V. Phone/Fax

Practice location:
  • Phone: 775-737-1639
  • Fax:
Mailing address:
  • Phone: 775-737-1639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS2-192
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: