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NPI Code Detail

MEDICARE: DR. GEOFFREY PAUL HERZOG D.M.D.

MEDICARE: DR. GEOFFREY PAUL HERZOG D.M.D.
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
11223G0001XGeneral Practice DentistryD-4570ID

General Provider Information

NPI Number : 1245513688
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEOFFREY PAUL HERZOG D.M.D.
Provider Business Mailing Address
First Line : 6657 N GLENWOOD ST
Second Line :
City : BOISE
State : ID
Zip : 83714-1925
Country : US
Telephone Number : 208-375-0572
Fax Number :
Provider Business Practice Location Address
First Line : 6657 N GLENWOOD ST
Second Line :
City : BOISE
State : ID
Zip : 83714-1925
Country : US
Telephone Number : 208-375-0572
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2011
Last Update Date : 07/12/2023

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