Provider Demographics
NPI:1548632631
Name:HERWIG, DDS, P.A.
Entity type:Organization
Organization Name:HERWIG, DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-294-4321
Mailing Address - Street 1:22 S SILVER ST
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1469
Mailing Address - Country:US
Mailing Address - Phone:913-294-4321
Mailing Address - Fax:
Practice Address - Street 1:22 S SILVER ST
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1469
Practice Address - Country:US
Practice Address - Phone:913-294-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty