Provider Demographics
NPI:1336365188
Name:HERRMANN, DAVID J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 N MILWAUKEE AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7345
Mailing Address - Country:US
Mailing Address - Phone:773-342-7244
Mailing Address - Fax:
Practice Address - Street 1:2956 N MILWAUKEE AVE
Practice Address - Street 2:STE 209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7345
Practice Address - Country:US
Practice Address - Phone:773-342-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice