Provider Demographics
NPI:1578670691
Name:DRS. HERMAN & MACK PC
Entity Type:Organization
Organization Name:DRS. HERMAN & MACK PC
Other - Org Name:SMILE QUEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLLIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-662-8191
Mailing Address - Street 1:206 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3602
Mailing Address - Country:US
Mailing Address - Phone:701-662-8191
Mailing Address - Fax:701-662-5757
Practice Address - Street 1:206 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3602
Practice Address - Country:US
Practice Address - Phone:701-662-8191
Practice Address - Fax:701-662-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40775Medicaid