Provider Demographics
NPI:1659562643
Name:HERZBERG, PAUL K (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:K
Last Name:HERZBERG
Suffix:
Gender:M
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:PO BOX 806
Mailing Address - Street 2:18 WILDERNESS LANE
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-0806
Mailing Address - Country:US
Mailing Address - Phone:518-758-6359
Mailing Address - Fax:
Practice Address - Street 1:18 WILDERNESS LANE
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-0806
Practice Address - Country:US
Practice Address - Phone:518-758-6359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice