AMY HERZOG (NPI# 1467856013) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467856013 |
| Entity Type | Individual |
| Full Name | AMY HERZOG |
| Credential | RDA |
| Practice Address |
12711 Se Mill Plain Blvd Vancouver WA 98684-6053 |
| Practice Telephone | 3608964484 |
| Practice Fax Number | 3608964489 |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2014-10-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 126800000X | Dental Assistant | 60060516 | WA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861534133 | Amy Herzog | Counselor | 175 Brome Dr., #7, Victor, ID 83455 | 2007-02-13 |
| Street Address |
12711 SE MILL PLAIN BLVD |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98684-6053 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479094 | Rosalyn Ellen Lamb | Dental Hygienist | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2019-10-24 |
| 1447714399 | Rimma Feldeshi | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2019-01-24 |
| 1477029908 | Lydia Kay Lyall | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2018-10-23 |
| 1891247029 | Kaiser Foundation Health Plan of The Northwest | Dentist | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2016-11-04 |
| 1033669833 | Charity Rebecca Ashworth | Dental Hygienist | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2016-10-05 |
| 1003277104 | Svetlana Anenko | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2016-03-16 |
| 1720449937 | Renee Mcqueen | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2016-03-15 |
| 1124497433 | Hilary Lee Beatty | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2015-09-16 |
| 1942699376 | Kristina Santiago | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2015-01-22 |
| 1770906026 | Kelly Jean Palmer | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2014-01-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285291849 | Pacifica Sylvan Park LLC | Alzheimer Center (Dementia Center) | 2400 Ne 112th Avenue, Vancouver, WA 98684 | 2019-05-20 |
| 1699242826 | Heidi Ericka Jackson | Registered Nurse | 15606 Ne 12th Way, Vancouver, WA 98684 | 2018-10-25 |
| 1477076727 | Brian Benasa Bardeloza | Dentist | 605 Se 164th Ave Ste 103, Vancouver, WA 98684 | 2017-07-19 |
| 1992226062 | Judith Moreno-castro | Massage Therapist | 2501 Ne 138th Ave., #60, Vancouver, WA 98684 | 2017-06-29 |
| 1346790706 | Samuel Joonsang Lee | Registered Nurse | 501 Se 172nd Ave Ste 210, Vancouver, WA 98684 | 2016-10-10 |
| 1912353178 | Cheryl A. Hamilton-jefferson | Counselor | 11818 Se Mill Plain Blvd Ste 311g, Vancouver, WA 98684 | 2016-05-06 |
| 1063866424 | Kim Forgione | Optometrist | 1900 Ne 162nd Ave Ste D103, Vancouver, WA 98684 | 2016-04-21 |
| 1700254257 | Desiree Haggart | Registered Nurse | 406 Se 131st St., Suite A101, Vancouver, WA 98684 | 2015-09-14 |
| 1215318068 | Paige M. King | Behavioral Analyst | 11818 Se Mill Plain Blvd Ste 203, Vancouver, WA 98684 | 2015-06-17 |
| 1417354366 | Amanda Hilkey, Lmp | Massage Therapist | 108 Se 24th Ave, Ste 9, Vancouver, WA 98684 | 2014-11-20 |
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| Taxonomy Code | 126800000X |
| Grouping | Dental Providers |
| Classification | Dental Assistant |
| An individual who may or may not have completed an accredited dental assisting education program and who aids the dentist in providing patient care services and performs other nonclinical duties in the dental office or other patient care facility. The scope of the patient care functions that may be legally delegated to the dental assistant varies based on the needs of the dentist the educational preparation of the dental assistant and state dental practice acts and regulations. Patient care services are provided under the supervision of a dentist. To avoid misleading the public, no occupational title other than dental assistant should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881161818 | Michelle Wolfe | Dental Assistant | A101, 1484, 14313 Ne 20th Ave, Vancouver, WA 98686 | 2018-10-29 |
| 1740670363 | Debra Jean Gibeson | Dental Assistant | 6100 Nw Cherry St, Vancouver, WA 98663-1034 | 2015-02-03 |
| 1528303708 | Brandie Hazelton | Dental Assistant | 5415 Ne 54th Ave, Vancouver, WA 98661-2165 | 2012-11-29 |
| 1700919990 | Katrina Gail Embree | Dental Assistant | 17401 Se 28th St, Vancouver, WA 98684-3427 | 2007-03-14 |
| 1205938529 | Beverly Jean Hart | Dental Assistant | 8500 Ne Hazel Dell Ave, Apt K12, Vancouver, WA 98665-8069 | 2006-09-05 |
| 1821632944 | Aleksandra S Velychko | Dental Assistant | 14406 Ne 20th Ave, Vancouver, WA 98686-1448 | 2019-10-31 |
| 1346892759 | Rebecca Olmsted | Dental Assistant | 14406 Ne 20th Ave, Vancouver, WA 98686-1448 | 2019-07-15 |
| 1447714399 | Rimma Feldeshi | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2019-01-24 |
| 1477029908 | Lydia Kay Lyall | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2018-10-23 |
| 1003277104 | Svetlana Anenko | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2016-03-16 |
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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.