MEDICARE: DR. RICHARD P HERMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	31123	NY

General Provider Information

NPI Number	:	1194728857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD P HERMAN DDS

Provider Business Mailing Address
First Line	:	PO BOX 528
Second Line	:
City	:	CORNWALL
State	:	NY
Zip	:	12518-0528
Country	:	US
Telephone Number	:	845-563-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 LAKE STREET
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-5242
Country	:	US
Telephone Number	:	845-563-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/21/2011

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