Provider Demographics
NPI:1689774200
Name:HERRMAN, BRENDA PHILLIPS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:PHILLIPS
Last Name:HERRMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4752 E TRAILWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-4318
Mailing Address - Country:US
Mailing Address - Phone:417-838-9199
Mailing Address - Fax:888-513-4125
Practice Address - Street 1:1406 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:MO
Practice Address - Zip Code:64865-9261
Practice Address - Country:US
Practice Address - Phone:417-776-2291
Practice Address - Fax:417-776-2292
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0151831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice