Provider Demographics
NPI:1912599929
Name:HERRMAN, ELISA ILSE-FRANCES (DMD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:ILSE-FRANCES
Last Name:HERRMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-7975
Mailing Address - Country:US
Mailing Address - Phone:269-605-9408
Mailing Address - Fax:
Practice Address - Street 1:9475 SW WILSONVILLE RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7522
Practice Address - Country:US
Practice Address - Phone:503-682-6984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD120721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics