Provider Demographics
NPI:1760641989
Name:JEFFREY F. HERMEN
Entity Type:Organization
Organization Name:JEFFREY F. HERMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HERMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-621-2100
Mailing Address - Street 1:13304 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-3021
Mailing Address - Country:US
Mailing Address - Phone:405-621-2100
Mailing Address - Fax:405-621-2110
Practice Address - Street 1:13304 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-3021
Practice Address - Country:US
Practice Address - Phone:405-621-2100
Practice Address - Fax:405-621-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty