Provider Demographics
NPI:1194750596
Name:HERMAN, BARRY LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:LEE
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BLUEWATER CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3558
Mailing Address - Country:US
Mailing Address - Phone:757-548-1871
Mailing Address - Fax:
Practice Address - Street 1:1300 KEMPSVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6199
Practice Address - Country:US
Practice Address - Phone:757-467-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-0068831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA088615OtherBLUE CROSS/BLUE SHIELD
PA817475OtherUNITED CONCORDIA COMPANIE
PA080982OtherUNITED CONCORDIA COMPANIE