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General NPI Number Information
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NPI Number | 1518207802
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Entity Type | Organization
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Legal Business Name | HERZOG SAN ANTONIO PC
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Dates
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Enumeration Date | 02/22/2013
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Last Update Date | 02/22/2013
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Provider Practice Location Address
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Address Line | 19903 STONE OAK PKWY BUILDING 1 SUITE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78258-6953
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Country | US
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Telephone | 210-293-0101
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Fax | 210-293-0102
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Provider Business Mailing Address
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Address Line | 19903 STONE OAK PKWY BUILDING 1 SUITE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78258-6953
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Country | US
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Telephone | 210-293-0101
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Fax | 210-293-0102
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLINTON FINCH HERZOG
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Credential | DDS
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Telephone | 214-218-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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