Provider Demographics
NPI:1659516516
Name:HERZBERG, ELIZABETH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6625 COUNTY ROAD A
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-5852
Mailing Address - Country:US
Mailing Address - Phone:715-284-3100
Mailing Address - Fax:715-284-8115
Practice Address - Street 1:N6625 COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5852
Practice Address - Country:US
Practice Address - Phone:715-284-3100
Practice Address - Fax:715-284-8115
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5149-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice