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General NPI Number Information
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NPI Number | 1215746300
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Entity Type | Organization
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Legal Business Name | ELISA HERRMAN DMD LLC
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 9475 SW WILSONVILLE RD
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City | WILSONVILLE
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State | OR
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Zip | 97070-7522
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Country | US
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Telephone | 269-605-9408
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Fax |
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Provider Business Mailing Address
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Address Line | 2518 NE 163RD ST
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City | RIDGEFIELD
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State | WA
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Zip | 98642-7975
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Country | US
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Telephone | 269-605-9408
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ELISA HERRMAN
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Credential | DMD, MS
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Telephone | 269-605-9408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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