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General NPI Number Information
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NPI Number | 1235120064
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Entity Type | Individual
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Provider Name | GREGORY STEPHEN HERZLER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4977 MACKINAW RD
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City | SAGINAW
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State | MI
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Zip | 48603-7248
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Country | US
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Telephone | 989-793-7733
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Fax | 989-793-6347
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Provider Business Mailing Address
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Address Line | 971 CANTERBURY DR
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City | SAGINAW
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State | MI
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Zip | 48638-5861
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Country | US
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Telephone | 989-793-2204
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Fax |
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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 | 12605
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License Number State | MI
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