Provider Demographics
NPI:1932614328
Name:HERMANN, DANIELLE LEE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEE
Last Name:HERMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 WILD HORSE RD
Mailing Address - Street 2:
Mailing Address - City:MC LOUTH
Mailing Address - State:KS
Mailing Address - Zip Code:66054-4222
Mailing Address - Country:US
Mailing Address - Phone:785-215-0682
Mailing Address - Fax:
Practice Address - Street 1:5437 WILD HORSE RD
Practice Address - Street 2:
Practice Address - City:MC LOUTH
Practice Address - State:KS
Practice Address - Zip Code:66054-4222
Practice Address - Country:US
Practice Address - Phone:785-215-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2377124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist