Individual
JOHN ANDREW HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
78 MCKAY ST, BEVERLY, MA 01915
(978) 922-4427
(978) 927-4937
Mailing address
78 MCKAY ST, BEVERLY, MA 01915
(978) 922-4427
(978) 927-4937
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15790
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
451193
BLUE CROSS BLUE SHIELD
MA
01
—
Y51193
MASSHEALTH
MA
Enumeration date
01/25/2007
Last updated
07/08/2007
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