Provider Demographics
NPI:1578777447
Name:HERTZBERG, DAVID RICHARD (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RICHARD
Last Name:HERTZBERG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Mailing Address - Street 1:160 COMMERCE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1601
Mailing Address - Country:US
Mailing Address - Phone:847-548-4330
Mailing Address - Fax:847-548-4335
Practice Address - Street 1:160 COMMERCE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1601
Practice Address - Country:US
Practice Address - Phone:847-548-4330
Practice Address - Fax:847-548-4335
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics