Provider Demographics
NPI:1902250954
Name:ROBERT V. HERWIG, D.D.S., PA
Entity Type:Organization
Organization Name:ROBERT V. HERWIG, D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:HERWIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-492-8884
Mailing Address - Street 1:11900 W 87TH STREET PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2807
Mailing Address - Country:US
Mailing Address - Phone:913-492-8884
Mailing Address - Fax:913-492-4582
Practice Address - Street 1:11900 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2807
Practice Address - Country:US
Practice Address - Phone:913-492-8884
Practice Address - Fax:913-492-4582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS57681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty