Provider Demographics
NPI:1457566358
Name:HERMANN, DONALD WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WAYNE
Last Name:HERMANN
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 1:555 W. GRANADA BLVD
Mailing Address - Street 2:SUITE E2
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-672-5151
Mailing Address - Fax:386-672-5313
Practice Address - Street 1:555 W. GRANADA BLVD
Practice Address - Street 2:SUITE E2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-672-5151
Practice Address - Fax:386-672-5313
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9626122300000X
FLDN9626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist