Provider Demographics
NPI:1376565424
Name:HERMAN, LEE ELIOT (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ELIOT
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 1:22053 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4219
Mailing Address - Country:US
Mailing Address - Phone:561-488-9288
Mailing Address - Fax:561-482-5005
Practice Address - Street 1:22053 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4219
Practice Address - Country:US
Practice Address - Phone:561-488-9288
Practice Address - Fax:561-482-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14006122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist