Provider Demographics
NPI:1902342264
Name:HERMANO, MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:HERMANO
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 1:6601 BRIDGMAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7941
Mailing Address - Country:US
Mailing Address - Phone:407-733-0184
Mailing Address - Fax:
Practice Address - Street 1:1319 E OSCEOLA PKWY STE C
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1606
Practice Address - Country:US
Practice Address - Phone:407-733-0184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 217451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry