Individual
DR. JEANINE LEA HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3653 SE 34TH AVE, PORTLAND, OR 97202
(503) 665-9616
(503) 666-0852
Mailing address
3653 SE 34TH AVE, PORTLAND, OR 97202-3034
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6133
OR
Other
Enumeration date
11/30/2006
Last updated
06/23/2016
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