Provider Demographics
NPI:1972721868
Name:DAVID MYLES HERMAN, LLC
Entity Type:Organization
Organization Name:DAVID MYLES HERMAN, LLC
Other - Org Name:SHORE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-747-4444
Mailing Address - Street 1:654 NEWMAN SPRINGS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1744
Mailing Address - Country:US
Mailing Address - Phone:732-747-4444
Mailing Address - Fax:732-747-4003
Practice Address - Street 1:654 NEWMAN SPRINGS RD
Practice Address - Street 2:SUITE A
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1744
Practice Address - Country:US
Practice Address - Phone:732-747-4444
Practice Address - Fax:732-747-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty