Healthcare Provider Details

I. General information

NPI: 1902329949
Provider Name (Legal Business Name): HERMANSON ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 N LINCOLN AVE STE 103
PIERRE SD
57501-7809
US

IV. Provider business mailing address

1709 N LINCOLN AVE STE 103
PIERRE SD
57501-7809
US

V. Phone/Fax

Practice location:
  • Phone: 605-280-5966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD1057
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BRIAN PATRICK HERMANSON
Title or Position: ENDODONTIST
Credential: DDS
Phone: 605-280-5966