Provider Demographics
NPI:1467817189
Name:SENECA FAMILY DENTAL BRENDA HERRMAN, DDS, LLC
Entity Type:Organization
Organization Name:SENECA FAMILY DENTAL BRENDA HERRMAN, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-838-9199
Mailing Address - Street 1:1406 CHESTNUT ST
Mailing Address - Street 2:PO BOX 455
Mailing Address - City:SENECA
Mailing Address - State:MO
Mailing Address - Zip Code:64865-9261
Mailing Address - Country:US
Mailing Address - Phone:417-776-2291
Mailing Address - Fax:888-513-4125
Practice Address - Street 1:1406 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:MO
Practice Address - Zip Code:64865-9261
Practice Address - Country:US
Practice Address - Phone:417-776-2291
Practice Address - Fax:888-513-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015183261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental