DR. MARK CARL HERZBERG (NPI# 1073731998) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073731998 |
| Entity Type | Individual |
| Full Name | DR. MARK CARL HERZBERG |
| Credential | DDS |
| Practice Address |
Va Medical Center One Veterans Drive Minneapolis MN 55417 |
| Mailing Address |
3927 York Ave S Minneapolis MN 55410-1164 |
| Practice Telephone | 6124674716 |
| Practice Fax Number | 6126262651 |
| Mailing Telephone | 6129297540 |
| Mailing Fax Number | 6126262651 |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
8687 | MN | Dental Providers |
| Street Address |
VA MEDICAL CENTER ONE VETERANS DRIVE |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174553549 | Nancy Marie Woody Haack | Audiologist | Va Medical Center, One Veterans Drive (126), Minneapolis, MN 55417 | 2006-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205444791 | Patrick Reilly Steck | Dentist | 4948 S 34th Ave, Minneapolis, MN 55417 | 2020-07-21 |
| 1174160832 | Susan Jacobson | Pharmacist | One Veterans Drive (119), Minneapolis, MN 55417 | 2019-12-02 |
| 1699240580 | Angela Cox | Social Worker | Vamc Minneapolis, 1 Veterans Drive (1k), Minneapolis, MN 55417 | 2018-10-08 |
| 1407353519 | Kirsten Kathleen Rydberg | Registered Nurse | One Veteran Drive, Minneapolis, MN 55417 | 2018-04-06 |
| 1902306038 | Ksa Psychological Services, LLC | Psychologist | 5603 Chicago Ave., Minneapolis, MN 55417 | 2018-02-15 |
| 1770025710 | Elizabeth Kate Adam | Registered Nurse | 613 E Minnehaha Pkwy, Minneapolis, MN 55417 | 2016-11-08 |
| 1831579754 | John Rossakis | Occupational Therapist | 5708 42nd Ave S, Minneapolis, MN 55417 | 2015-06-05 |
| 1205214566 | Karin Shelstad | Specialist/Technologist | 5501 10th Av S, Minneapolis, MN 55417 | 2015-05-07 |
| 1750712733 | Debra Sand | Massage Therapist | 2750 E 50th Street, Minneapolis, MN 55417 | 2013-12-02 |
| 1669764221 | Michael Alan Newman | Internal Medicine | One Veterans Drive (111-0), Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417 | 2011-05-13 |
| Find all providers in zip 55417 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316400591 | Shorouk Elnagdy | Dentist | 515 Delaware St Se # 7-368, Minneapolis, MN 55455-0357 | 2019-04-13 |
| 1861784050 | Elham Akhlaghi | Dentist | 515 Delaware Street, Minneapolis, MN 55455 | 2011-05-06 |
| 1972770006 | Ying-lien Wu | Dentist | 150 S 5th St Ste 1475, Minneapolis, MN 55402-4212 | 2008-05-08 |
| 1417020017 | Glenn I Lepor | Dentist | 3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352 | 2006-11-15 |
| 1548756984 | Barbara Botorous | Dentist | 515 Delaware St Se, Minneapolis, MN 55455-0357 | 2018-07-09 |
| 1851884712 | Alessandro Pedercini | Dentist | 515 Delaware Street Se, 7-368 Moos Health Science Tower, Minneapolis, MN 55455 | 2018-06-14 |
| 1679904429 | Ryan Wolff | Dentist | 515 Delaware St Se, 7-360 Moos Tower, Minneapolis, MN 55455-0357 | 2013-12-04 |
| 1417213695 | Sofia Karadimitriou | Dentist | 515 Delaware St Se, School of Dentistry, Minneapolis, MN 55455-0357 | 2012-04-02 |
| 1245506849 | Bashar Bakdash | Dentist | 515 Delaware St Se, 7-368 Mhst, Minneapolis, MN 55455-0357 | 2012-03-28 |
| 1649563040 | Massimo Costalonga | Dentist | 516 Delaware St Se, 7-300 Pwb, Minneapolis, MN 55455-0356 | 2011-05-18 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55417 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.