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10587 Double R Blvd Ste 100 Reno NV 89521-8966 | |
| (775) 737-1639 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 10587 Double R Blvd Ste 100, Reno, Nevada |
| Authorized Official Name and Position | Brandyn Herman (OWNER) |
| Authorized Official Contact | 7757371639 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
10587 Double R Blvd Ste 100 Reno NV 89521-8966 Ph: (775) 971-4861 | 10587 Double R Blvd Ste 100 Reno NV 89521-8966 Ph: (775) 737-1639 |
| NPI Number | 1104530161 |
|---|---|
| Provider Enumeration Date | 01/12/2023 |
| Last Update Date | 05/03/2023 |
| Medicare PECOS PAC ID | 3779940317 |
|---|---|
| Medicare Enrollment ID | O20230613001526 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104530161 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Brandyn Matthew Herman |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1689060808 PECOS PAC ID: 2769782846 Enrollment ID: I20240823001093 |
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