Provider Demographics
NPI:1316194392
Name:HERMAN, RICHARD T (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 N SUSQUEHANNA TRL STE 340
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-8974
Mailing Address - Country:US
Mailing Address - Phone:570-743-1155
Mailing Address - Fax:570-743-7205
Practice Address - Street 1:1372 N SUSQUEHANNA TRL STE 340
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-8974
Practice Address - Country:US
Practice Address - Phone:570-743-1155
Practice Address - Fax:570-743-7205
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026861L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics