Provider Demographics
NPI:1518207802
Name:HERZOG SAN ANTONIO PC
Entity Type:Organization
Organization Name:HERZOG SAN ANTONIO PC
Other - Org Name:FLOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:FINCH
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-218-1666
Mailing Address - Street 1:19903 STONE OAK PKWY
Mailing Address - Street 2:BUILDING 1 SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-6953
Mailing Address - Country:US
Mailing Address - Phone:210-293-0101
Mailing Address - Fax:210-293-0102
Practice Address - Street 1:19903 STONE OAK PKWY
Practice Address - Street 2:BUILDING 1 SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-6953
Practice Address - Country:US
Practice Address - Phone:210-293-0101
Practice Address - Fax:210-293-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty