=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316363682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD ALMASSY DDS TIMOTHY HERMAN DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2014
-----------------------------------------------------
Last Update Date | 03/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 945 ORCHARD CREEK LN STE 200
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95648-8473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-408-5557
-----------------------------------------------------
Fax | 916-409-0906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 945 ORCHARD CREEK LN STE 200
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95648-8473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-408-5557
-----------------------------------------------------
Fax | 916-409-0906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. TIMOTHY JAMES HERMAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 916-784-1144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 36937
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------