Andrea Wise Herzog, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN25630 Issued in FL

Practice address

2529 Santa Barbara Blvd Ste 100
Cape Coral, FL 33914-4447

Phone

(239) 800-3955

Fax

(239) 205-2221

NPI assigned

Mar 19, 2020

Sex

Female

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

Practice roles

Networks

• Freedom Health HMO Network

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73767

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Health Centers of Southwest Florida

  • Dental Clinic/Center
  • Fort Myers, FL
  • NPI 1790166999
  NPD (past)

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1881220093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2529 SANTA BARBARA BLVD STE 100",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339144447",
            "telephone_number": "239-800-3955",
            "fax_number": "239-800-3929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2529 SANTA BARBARA BLVD STE 100",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339144447",
            "telephone_number": "239-800-3955",
            "fax_number": "239-205-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE HERZOG",
        "first_name": "ANDREA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-19",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN25630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Windsor of Cape Coral
• Randel B. Wing, DOM, LAC., NMD
• Richard H Wingert, MD
• Donna Marie Winsor, RN,BSN
• Jasmine Winters
• Nicole Wise
• James Michael Witherington, OD
• Michael Andrew Withers, L.M.T.
• Victoria Wittrock
• Paula Brittany Nicole Wolfer, PSYD

• General Practice Dentistry in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; 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.