Provider Demographics
NPI:1871882415
Name:HERZBERG, GREGORY (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:HERZBERG
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 1:7631 SHAFFER PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3011
Mailing Address - Country:US
Mailing Address - Phone:303-973-5280
Mailing Address - Fax:303-973-7996
Practice Address - Street 1:7631 SHAFFER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-3011
Practice Address - Country:US
Practice Address - Phone:303-973-5280
Practice Address - Fax:303-973-7996
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice