Mark A.Herzog
Dentist in Ellsworth, KS. Organization (NPI-2).
NPI number1487992004
StatusActive
Last updated in NPPESJan 17, 2013
Details
- NPI
- 1487992004
- Entity type
- Organization (NPI-2)
- Legal business name
- Mark A.Herzog
- Organization subpart
- No
- Enumeration date
- Jan 17, 2013
- Last updated
- Jan 17, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 6269 | KS | Yes |
Practice location
804 E 8th StEllsworth, KS 67439-2535
Phone 785-472-5420 · Fax 785-472-8995
Mailing address
804 E 8th StEllsworth, KS 67439-2535
Phone 785-472-5420 · Fax 785-472-8995
Authorized official
Mark Alan Herzog
President
7854725420
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