Provider Demographics
NPI:1063500965
Name:HERMAN, RICHARD I (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:I
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19523 CEDAR GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5132
Mailing Address - Country:US
Mailing Address - Phone:561-482-3990
Mailing Address - Fax:561-482-3990
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:WEST PALM BEACH VAMC-DENTAL SERVICE(160)
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-5675
Practice Address - Fax:561-422-8595
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0264491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics