Individual
DR. MARK BRADY HERZOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
6520 226TH PL SE, SUITE 200, ISSAQUAH, WA 98027-8969
(425) 392-1010
Mailing address
6911 RAVENS GATE WAY, YAKIMA, WA 98908-2189
(509) 965-4718
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60566577
WA
Other
Enumeration date
06/22/2015
Last updated
06/22/2015
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