Organization
MARK A.HERZOG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALAN HERZOG D.D.S. (PRESIDENT)
(785) 472-5420
Entity
Organization
Contact information
Practice address
804 E 8TH ST, ELLSWORTH, KS 67439-2535
(785) 472-5420
(785) 472-8995
Mailing address
804 E 8TH ST, ELLSWORTH, KS 67439-2535
(785) 472-5420
(785) 472-8995
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6269
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100223300B
—
KS
Enumeration date
01/17/2013
Last updated
01/17/2013
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