Provider Demographics
NPI:1447258793
Name:HERZIK, ALAN LOUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LOUIS
Last Name:HERZIK
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 1:717 UPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-1565
Mailing Address - Country:US
Mailing Address - Phone:979-743-4138
Mailing Address - Fax:979-743-2648
Practice Address - Street 1:717 UPTON AVE
Practice Address - Street 2:
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1565
Practice Address - Country:US
Practice Address - Phone:979-743-4138
Practice Address - Fax:979-743-2648
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice