Provider Demographics
NPI:1578507729
Name:HERMAN, S. CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:S.
Middle Name:CRAIG
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:J
Other - Last Name:ECKHARDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MSD
Mailing Address - Street 1:201C VAN GUNDY DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1154
Mailing Address - Country:US
Mailing Address - Phone:419-636-5918
Mailing Address - Fax:419-636-0752
Practice Address - Street 1:201C VAN GUNDY DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1154
Practice Address - Country:US
Practice Address - Phone:419-636-5918
Practice Address - Fax:419-636-0752
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168821223X0400X
OH210181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0852779Medicaid
OH2412900Medicaid