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

Organization subpart

No

Name

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

Title

President

Phone

(785) 472-5420

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark A. Herzog, D.D.S, P.A.

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

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 17, 2013.

{
    "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": "193400000X SINGLE SPECIALTY  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.

• All providers in Ellsworth, KS
• 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.