Provider Demographics
NPI:1235120064
Name:HERZLER, GREGORY STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEPHEN
Last Name:HERZLER
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 1:971 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5861
Mailing Address - Country:US
Mailing Address - Phone:989-793-2204
Mailing Address - Fax:
Practice Address - Street 1:4977 MACKINAW RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7248
Practice Address - Country:US
Practice Address - Phone:989-793-7733
Practice Address - Fax:989-793-6347
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI126051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N47150Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER