MEDICARE: DR. MERYL AMY HERTZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	009322	CT

General Provider Information

NPI Number	:	1073743688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERYL AMY HERTZ DDS

Provider Business Mailing Address
First Line	:	1 WOODLAND DR
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-5051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 MAIN ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-7834
Country	:	US
Telephone Number	:	203-743-9760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	10/12/2016

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