Provider Demographics
NPI:1598866477
Name:HERMAN, MICHAEL ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROY
Last Name:HERMAN
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 1:128 CENTRAL PARK S
Mailing Address - Street 2:SUITE 1 A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1565
Mailing Address - Country:US
Mailing Address - Phone:212-582-3322
Mailing Address - Fax:212-582-3784
Practice Address - Street 1:128 CENTRAL PARK S
Practice Address - Street 2:SUITE 1 A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1565
Practice Address - Country:US
Practice Address - Phone:212-582-3322
Practice Address - Fax:212-582-3784
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0326401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice