Provider Demographics
NPI:1265616338
Name:HERZOG, JOSEPH BERNARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BERNARD
Last Name:HERZOG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72724 TWENTYNINE PALMS HWY
Mailing Address - Street 2:SUITE #102
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-1461
Mailing Address - Country:US
Mailing Address - Phone:760-367-6755
Mailing Address - Fax:760-367-5016
Practice Address - Street 1:5TH & WESTERN
Practice Address - Street 2:CALIFORNIA REHABILITATION CENTER
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860
Practice Address - Country:US
Practice Address - Phone:951-737-2683
Practice Address - Fax:951-273-2326
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA359001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice