Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 4370 | SC |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN1855567 | MA |
NPI | 1093913048 |
---|---|
Provider Name | Kurt Thomas Herman |
First Address | Walpole, MA 02081 |
Second Address | Walpole, MA 02081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 13/06/2016 |