Organization
HERZOG SOUTHLAKE PC
Active
Other names
FLOSS
Organization subpart
No
Provider details
NPI number
Authorized official
CLINTON F HERZOG DDS (OWNER)
(817) 328-0110
Entity
Organization
Contact information
Practice address
2600 E SOUTHLAKE BLVD, SUITE 170, SOUTHLAKE, TX 76092-6634
(817) 328-0110
(817) 328-0121
Mailing address
2600 E SOUTHLAKE BLVD, SUITE 170, SOUTHLAKE, TX 76092-6634
(817) 328-0110
(817) 328-0121
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
TX
Other
Enumeration date
03/30/2012
Last updated
03/30/2012
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