Provider Demographics
NPI:1164442695
Name:HERSCH, I WARREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:I
Middle Name:WARREN
Last Name:HERSCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:I
Other - Middle Name:WARREN
Other - Last Name:HERSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:823 DUNLAWTON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4220
Mailing Address - Country:US
Mailing Address - Phone:386-763-9413
Mailing Address - Fax:386-763-5833
Practice Address - Street 1:823 DUNLAWTON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4220
Practice Address - Country:US
Practice Address - Phone:386-763-9413
Practice Address - Fax:386-763-5833
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice