Provider Demographics
NPI:1770849952
Name:HERZOG WEST 38TH PC
Entity Type:Organization
Organization Name:HERZOG WEST 38TH 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:512-615-0100
Mailing Address - Street 1:1005 W 38TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1002
Mailing Address - Country:US
Mailing Address - Phone:512-615-0100
Mailing Address - Fax:512-615-0121
Practice Address - Street 1:1005 W 38TH ST
Practice Address - Street 2:STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1002
Practice Address - Country:US
Practice Address - Phone:512-615-0100
Practice Address - Fax:512-615-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty