Mark a.Herzog

Primary specialty

DentistTaxonomy code 122300000X

License

6269 Issued in KS

Legal business name

MARK A.HERZOG

Practice address

804 E 8TH St
Ellsworth, KS 67439-2535

Phone

(785) 472-5420

Fax

(785) 472-8995

NPI assigned

Jan 17, 2013

Last updated

Jan 17, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Alan Herzog, D.D.S.NPI 1275595290

Title

President

Phone

(785) 472-5420

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark A. Herzog, D.D.S, P.A.

  • General Practice Dentistry
  • Ellsworth, KS
  • NPI 1275595290
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358380800000",
    "number": "1487992004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 E 8TH ST",
            "city": "ELLSWORTH",
            "state": "KS",
            "postal_code": "674392535",
            "telephone_number": "785-472-5420",
            "fax_number": "785-472-8995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 E 8TH ST",
            "city": "ELLSWORTH",
            "state": "KS",
            "postal_code": "674392535",
            "telephone_number": "785-472-5420",
            "fax_number": "785-472-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK A.HERZOG",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-17",
        "last_updated": "2013-01-17",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "785-472-5420",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "6269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100223300B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle Gwinner OD LLC
• Ryan T Lahey, PA-C
• Emily S Lindsley, ARNP
• Trevor Benjamin Lowe, PTA
• Kourtney Maisog
• Joseph Duane McBeain, CRNA
• Shawn Aaron McGowan, PA
• Mosaic
• Jennifer Nemnich, PHARMD
• Oak Creek Chiropractic, LLC.

• Dentist in Ellsworth, KS
• Providers in Ellsworth, KS by specialty
• Dentist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.