Provider Demographics
NPI:1548484181
Name:HERMAN, BRUCE NEIL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:NEIL
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:NEIL
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8418 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3042
Mailing Address - Country:US
Mailing Address - Phone:718-835-0911
Mailing Address - Fax:718-835-9873
Practice Address - Street 1:8418 160TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3042
Practice Address - Country:US
Practice Address - Phone:718-835-0911
Practice Address - Fax:718-835-9873
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041284-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice