MEDICARE: DR. COLE JOSEPH HERZIK DMD

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	1223G0001X	General Practice Dentistry	8192	NV
2	1223G0001X	General Practice Dentistry	109088	CA
3	1223G0001X	General Practice Dentistry	DN28665	FL

General Provider Information

NPI Number	:	1679351159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLE JOSEPH HERZIK DMD

Provider Business Mailing Address
First Line	:	10235 TAIT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-8011
Country	:	US
Telephone Number	:	772-538-0990
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 BOULDER HWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6076
Country	:	US
Telephone Number	:	702-851-6724
Fax Number	:

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

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	10/26/2025

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