Individual
STEVEN HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
2440 W PETERSON AVE, CHICAGO, IL 60659-4113
(773) 761-7171
(773) 761-6714
Mailing address
2440 W PETERSON AVE, CHICAGO, IL 60659-4113
(773) 761-7171
(773) 761-6714
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
019-016111
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
019-016111
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019016111
—
IL
Enumeration date
04/19/2007
Last updated
12/16/2019
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