Healthcare Provider Details

I. General information

NPI: 1851396931
Provider Name (Legal Business Name): JAMES JOHN HERGET DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1766 HORICON ST
MAYVILLE WI
53050-1256
US

IV. Provider business mailing address

1766 HORICON ST
MAYVILLE WI
53050-1256
US

V. Phone/Fax

Practice location:
  • Phone: 920-387-5810
  • Fax: 920-387-9201
Mailing address:
  • Phone: 920-387-5810
  • Fax: 920-387-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3919-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: