Provider Demographics
NPI:1093934234
Name:DAVID G. BERKHEIM DDS PC
Entity Type:Organization
Organization Name:DAVID G. BERKHEIM DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BERKHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-773-4519
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:NE
Mailing Address - Zip Code:68979-0594
Mailing Address - Country:US
Mailing Address - Phone:402-773-4519
Mailing Address - Fax:
Practice Address - Street 1:301 S WAY AVE
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:NE
Practice Address - Zip Code:68979-2134
Practice Address - Country:US
Practice Address - Phone:402-773-4519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5135261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid