Healthcare Provider Details

I. General information

NPI: 1861545626
Provider Name (Legal Business Name): PATRICK R HERMANSON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 S CENTRAL AVE
PIERRE SD
57501-4508
US

IV. Provider business mailing address

433 S CENTRAL AVE
PIERRE SD
57501-4508
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5966
  • Fax: 605-224-7038
Mailing address:
  • Phone: 605-224-5966
  • Fax: 605-224-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK R HERMANSON
Title or Position: OWNER
Credential:
Phone: 605-224-5966