Provider Demographics
NPI:1780657650
Name:HERRMANN, ROBERT CHRISTY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHRISTY
Last Name:HERRMANN
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 1:34800 BOB WILSON DR
Mailing Address - Street 2:NMCSD, ATTN: MEDICAL
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-532-6460
Mailing Address - Fax:619-532-6299
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:NMCSD, ATTN: MEDICAL
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-6460
Practice Address - Fax:619-532-6299
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice