Provider Demographics
NPI:1306836028
Name:HERTZBERG, MARC (DMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:HERTZBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 PARK CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-3005
Mailing Address - Country:US
Mailing Address - Phone:814-231-7668
Mailing Address - Fax:814-231-7665
Practice Address - Street 1:2590 PARK CENTER BLVD
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3005
Practice Address - Country:US
Practice Address - Phone:814-231-7668
Practice Address - Fax:814-231-7665
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030819L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics