Provider Demographics
NPI:1689060808
Name:HERMAN, BRANDYN (DMD)
Entity Type:Individual
Prefix:
First Name:BRANDYN
Middle Name:
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10587 DOUBLE R BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8966
Mailing Address - Country:US
Mailing Address - Phone:775-737-1639
Mailing Address - Fax:
Practice Address - Street 1:10587 DOUBLE R BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8966
Practice Address - Country:US
Practice Address - Phone:775-737-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-1921223S0112X
KY104131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty