Provider Demographics
NPI:1609200773
Name:HERZOG CINCO RANCH PC
Entity Type:Organization
Organization Name:HERZOG CINCO RANCH PC
Other - Org Name:FLOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:F
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-589-0671
Mailing Address - Street 1:9727 SPRING GREEN BLVD
Mailing Address - Street 2:#200
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:832-589-0671
Mailing Address - Fax:832-589-0677
Practice Address - Street 1:9727 SPRING GREEN BLVD
Practice Address - Street 2:#200
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:832-589-0671
Practice Address - Fax:832-589-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty