Provider Demographics
NPI:1467945378
Name:HERZOG, LAUREN ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ANN
Last Name:HERZOG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:MCGOVERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2403
Mailing Address - Country:US
Mailing Address - Phone:218-739-2481
Mailing Address - Fax:218-739-2178
Practice Address - Street 1:321 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2403
Practice Address - Country:US
Practice Address - Phone:218-739-2481
Practice Address - Fax:218-739-2178
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice