Provider Demographics
NPI:1619217908
Name:HERZOG LAKEWOOD PC
Entity Type:Organization
Organization Name:HERZOG LAKEWOOD 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:214-389-0100
Mailing Address - Street 1:1920 ABRAMS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6218
Mailing Address - Country:US
Mailing Address - Phone:214-389-0100
Mailing Address - Fax:214-389-0101
Practice Address - Street 1:1920 ABRAMS PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-6218
Practice Address - Country:US
Practice Address - Phone:214-389-0100
Practice Address - Fax:214-389-0101
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