=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942461603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS. BEHRINGER, HERMAN AND ECKHARDT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2008
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 VAN GUNDY DR BUILDING C
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43506-1179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-636-5918
-----------------------------------------------------
Fax | 419-636-0752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 VAN GUNDY DR BUILDING C
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43506-1179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-636-5918
-----------------------------------------------------
Fax | 419-636-0752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. S CRAIG HERMAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 419-636-5918
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 21018
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 18481
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 16882
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------