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General NPI Number Information
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NPI Number | 1124250543
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Entity Type | Individual
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Provider Name | CHARLES F HERTZOG DMD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 118 DICKERSON RD SUITE D
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City | NORTH WALES
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State | PA
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Zip | 19454-2538
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Country | US
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Telephone | 215-699-9058
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Fax | 215-699-9599
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Provider Business Mailing Address
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Address Line | 118 DICKERSON RD SUITE D
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City | NORTH WALES
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State | PA
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Zip | 19454-2538
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Country | US
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Telephone | 215-699-9058
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Fax | 215-699-9599
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS024908L
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License Number State | PA
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