Herzog Southlake PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

HERZOG SOUTHLAKE PC

Practice address

2600 E Southlake Blvd
Suite 170
Southlake, TX 76092-6634

Phone

(817) 328-0110

Fax

(817) 328-0121

NPI assigned

Mar 30, 2012

Organization subpart

No

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

Authorized official

Name

Clinton F Herzog, DDS

Title

Owner

Phone

(817) 328-0110

Specialties & licenses 1

Addresses

Other names 1

• FLOSS Doing business as

Locations

Practitioners 1

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

• Kinnari Jayesh Ghia, DDS

  • General Practice Dentistry
  • Wichita Falls, TX
  • NPI 1255358966
  NPD (past)

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1922374263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 E SOUTHLAKE BLVD",
            "address_2": "SUITE 170",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926634",
            "telephone_number": "817-328-0110",
            "fax_number": "817-328-0121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E SOUTHLAKE BLVD",
            "address_2": "SUITE 170",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926634",
            "telephone_number": "817-328-0110",
            "fax_number": "817-328-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERZOG SOUTHLAKE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-30",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-328-0110",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FLOSS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Analise Maria Hernandez
• Christine Hernandez, PT, DPT
• Pedro Hernandez
• Sandra Hernandez, DDS
• Victoria C Heron, DDS
• Brooke Hessling, FNP-NP
• Cheryl A Hickey, PA-C
• Jessica Matocha Hickey, SLP
• Ashley A Hickman, FNP
• Allevion Hicks

• Dentist in Southlake, TX
• Providers in Southlake, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; 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.