Provider Demographics
NPI:1679351159
Name:HERZIK, COLE JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:COLE
Middle Name:JOSEPH
Last Name:HERZIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 46TH SQ
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-1178
Mailing Address - Country:US
Mailing Address - Phone:772-538-0990
Mailing Address - Fax:
Practice Address - Street 1:2155 PONCE DE LEON CIR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5337
Practice Address - Country:US
Practice Address - Phone:772-567-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN286651223G0001X
CA1090881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice