| Mark A.herzog | |
|
804 E 8th St Ellsworth KS 67439-2535 | |
| (785) 472-5420 | |
| (785) 472-8995 |
| Full Name | Mark A.herzog |
|---|---|
| Speciality | Dentist |
| Location | 804 E 8th St, Ellsworth, Kansas |
| Authorized Official Name and Position | Mark Alan Herzog (PRESIDENT) |
| Authorized Official Contact | 7854725420 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark A.herzog 804 E 8th St Ellsworth KS 67439-2535 Ph: (785) 472-5420 | Mark A.herzog 804 E 8th St Ellsworth KS 67439-2535 Ph: (785) 472-5420 |
| NPI Number | 1487992004 |
|---|---|
| Provider Enumeration Date | 01/17/2013 |
| Last Update Date | 01/17/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487992004 | NPI | - | NPPES |
| 100223300B | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6269 (Kansas) | Primary |
Cental Kansas Dentistry, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 202 N Douglas Ave, Ellsworth, KS 67439 Phone: 785-472-3803 Fax: 785-472-3620 |