Provider Demographics
NPI:1548272487
Name:DRS. HERMAN & MACK, P.C
Entity type:Organization
Organization Name:DRS. HERMAN & MACK, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLLIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-968-2530
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:HIGHWAY 281 N
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324-0688
Mailing Address - Country:US
Mailing Address - Phone:701-968-2530
Mailing Address - Fax:701-968-2532
Practice Address - Street 1:HIGHWAY 281 N
Practice Address - Street 2:TOWNER COUNTY MEDICAL CENTER
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324-0688
Practice Address - Country:US
Practice Address - Phone:701-968-2530
Practice Address - Fax:701-968-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41255Medicaid