Mark Brady Herzog, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60566577 Issued in WA

Practice address

6520 226TH PL SE
Suite 200
Issaquah, WA 98027-8969

Phone

(425) 392-1010

NPI assigned

Jun 22, 2015

Last updated

Jun 22, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434931200000",
    "number": "1740662246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6911 RAVENS GATE WAY",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989082189",
            "telephone_number": "509-965-4718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 226TH PL SE",
            "address_2": "SUITE 200",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278969",
            "telephone_number": "425-392-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERZOG",
        "first_name": "MARK",
        "middle_name": "BRADY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-22",
        "last_updated": "2015-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60566577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizaveta Hermann
• Jenny Lynn Hermanson, M.S. LMFT
• Melania Judith Hernandez Romero
• Tiffany Lynne Herr, MD
• Katie Hertzberg, DPT
• Nancy Hesselroth
• Valerie Hewell, PH.D.
• Sarah Hiam, D.O.
• Joshua Nakeithen Hicks
• Traci Lynn Hiegel, MD

• General Practice Dentistry in Issaquah, WA
• Providers in Issaquah, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; 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.