Provider Demographics
NPI:1437202579
Name:HERRMANN, PAUL E (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:HERRMANN
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 1:1248 HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:HAMEL
Mailing Address - State:MN
Mailing Address - Zip Code:55340-9605
Mailing Address - Country:US
Mailing Address - Phone:763-478-9549
Mailing Address - Fax:
Practice Address - Street 1:2040 DOUGLAS DR N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3944
Practice Address - Country:US
Practice Address - Phone:763-544-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN82981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice