Provider Demographics
NPI:1861745853
Name:HERZOG COPPELL PC
Entity type:Organization
Organization Name:HERZOG COPPELL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:FINCH
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-635-0100
Mailing Address - Street 1:143 S DENTON TAP RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3204
Mailing Address - Country:US
Mailing Address - Phone:469-635-0100
Mailing Address - Fax:469-635-0101
Practice Address - Street 1:143 S DENTON TAP RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3204
Practice Address - Country:US
Practice Address - Phone:469-635-0100
Practice Address - Fax:469-635-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty