Provider Demographics
NPI:1104530161
Name:ALPINE ORAL FACIAL SURGERY, BRANDYN HERMAN, PLLC
Entity type:Organization
Organization Name:ALPINE ORAL FACIAL SURGERY, BRANDYN HERMAN, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:775-737-1639
Mailing Address - Street 1:10587 DOUBLE R BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8966
Mailing Address - Country:US
Mailing Address - Phone:775-971-4861
Mailing Address - Fax:775-376-1066
Practice Address - Street 1:10587 DOUBLE R BLVD STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8966
Practice Address - Country:US
Practice Address - Phone:775-737-1639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty