Provider Demographics
NPI:1396041703
Name:SANTIAGO HERZOG, TATIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:SANTIAGO HERZOG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1109
Mailing Address - Country:US
Mailing Address - Phone:305-409-5392
Mailing Address - Fax:786-221-4442
Practice Address - Street 1:1160 KANE CONCOURSE STE 203
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2020
Practice Address - Country:US
Practice Address - Phone:305-560-5859
Practice Address - Fax:786-221-4442
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist