Provider Demographics
NPI:1154456283
Name:HERMAN, EDWARD C (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13525 JUG ST RD NW
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-8504
Mailing Address - Country:US
Mailing Address - Phone:740-967-1367
Mailing Address - Fax:
Practice Address - Street 1:111 W JOHNSTOWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2714
Practice Address - Country:US
Practice Address - Phone:614-471-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300173511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice