Provider Demographics
NPI:1619030848
Name:HERRMANN, RICK (DDS MS)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MATLOCK RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:817-473-9880
Mailing Address - Fax:817-473-3818
Practice Address - Street 1:2300 MATLOCK RD
Practice Address - Street 2:SUITE 28
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-473-9880
Practice Address - Fax:817-473-3818
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0169671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86D839OtherBCBS