Thomas W. Herfort, D.M.D.

Individual provider Active NPI General Practice Dentistry · Ironwood, MI

NPI 1376568089 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1376568089
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
2901012289 (MI)
Practice address
204 Harrison St
Ironwood, MI 49938-1714
Phone
(906) 932-1332
Fax
(906) 932-4337
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
2901012289MIMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901012289 MI Yes

Addresses

Primary practice location

204 Harrison St
Ironwood, MI 49938-1714

Mailing address

204 Harrison St
Ironwood, MI 49938-1714
Phone (906) 932-1332

Other providers in Ironwood, MI

All providers in Ironwood, MI · General Practice Dentistry in Michigan

Sources for this page

Verify at the official NPI Registry.