MEDICARE: LORI HERMAN DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS042184	PA

General Provider Information

NPI Number	:	1841966637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI HERMAN DMD

Provider Business Mailing Address
First Line	:	408 SPRUCE ST APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4247
Country	:	US
Telephone Number	:	215-565-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1352 SOUTH ST STE C3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1858
Country	:	US
Telephone Number	:	215-800-1495
Fax Number	:

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

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	08/20/2021

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