Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1003384108 |
---|---|
Provider Name | Ms. Pamela Fay Herzog |
First Address | Spring, TX 77379-4800 |
Second Address | Spring, TX 77379-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2018 |
Last Update Date | 06/11/2018 |