Healthcare Provider Details

I. General information

NPI: 1902084056
Provider Name (Legal Business Name): ALLEN K HERPY DDS MS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 MAYFIELD RD # 420
CLEVELAND OH
44124-2299
US

IV. Provider business mailing address

6770 MAYFIELD RD # 420
CLEVELAND OH
44124-2299
US

V. Phone/Fax

Practice location:
  • Phone: 440-460-2820
  • Fax: 440-460-2830
Mailing address:
  • Phone: 440-460-2820
  • Fax: 440-460-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30018513
License Number StateOH

VIII. Authorized Official

Name: DR. ALLEN K HERPY
Title or Position: ORAL SURGEON
Credential:
Phone: 440-460-2820