Healthcare Provider Details

I. General information

NPI: 1003986381
Provider Name (Legal Business Name): CHRISTOPHER W HERZOG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E HOLLAND AVE STE 222
SPOKANE WA
99218-1246
US

IV. Provider business mailing address

1502 E VANETTA LN
SPOKANE WA
99217-5515
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-5437
  • Fax: 509-755-0444
Mailing address:
  • Phone: 509-290-6031
  • Fax: 509-755-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10414
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: