Individual
JOSHUA HERMANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2028 E RIVERSIDE BLVD, SUITE 210, LOVES PARK, IL 61111-4804
(815) 877-4300
Mailing address
2028 E RIVERSIDE BLVD, SUITE 210, LOVES PARK, IL 61111-4804
(815) 877-4300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.030835
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019.030835
DENTIST
IL
Enumeration date
07/15/2016
Last updated
07/15/2016
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