Provider Demographics
NPI:1457450264
Name:HERMANN, GARY ROGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROGER
Last Name:HERMANN
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 1:14805 DETROIT AVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3934
Mailing Address - Country:US
Mailing Address - Phone:216-521-3510
Mailing Address - Fax:216-521-7590
Practice Address - Street 1:14805 DETROIT AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3934
Practice Address - Country:US
Practice Address - Phone:216-521-3510
Practice Address - Fax:216-521-7590
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice