Provider Demographics
NPI:1154592681
Name:HERMAN FAMILY DENTAL,LLC
Entity type:Organization
Organization Name:HERMAN FAMILY DENTAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-882-1572
Mailing Address - Street 1:706 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4356
Mailing Address - Country:US
Mailing Address - Phone:812-882-1572
Mailing Address - Fax:812-882-4450
Practice Address - Street 1:706 S 15TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4356
Practice Address - Country:US
Practice Address - Phone:812-882-1572
Practice Address - Fax:812-882-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12010409A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty