Healthcare Provider Details

I. General information

NPI: 1548632631
Provider Name (Legal Business Name): HERWIG, DDS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S SILVER ST
PAOLA KS
66071-1469
US

IV. Provider business mailing address

22 S SILVER ST
PAOLA KS
66071-1469
US

V. Phone/Fax

Practice location:
  • Phone: 913-294-4321
  • Fax:
Mailing address:
  • Phone: 913-294-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HERWIG
Title or Position: OFFICE MANAGER
Credential:
Phone: 913-294-4321