Provider Demographics
NPI:1093147522
Name:BERLS, LISA T (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:T
Last Name:BERLS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 ROUTE 146
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3616
Mailing Address - Country:US
Mailing Address - Phone:518-371-0224
Mailing Address - Fax:518-371-8931
Practice Address - Street 1:981 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3616
Practice Address - Country:US
Practice Address - Phone:518-371-0224
Practice Address - Fax:518-371-8931
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0490011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice