Provider Demographics
NPI:1124602669
Name:BUBBLE CHILDREN'S DENTISTRY AND ORTHODONTICS
Entity Type:Organization
Organization Name:BUBBLE CHILDREN'S DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-655-9410
Mailing Address - Street 1:792 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1977
Mailing Address - Country:US
Mailing Address - Phone:617-655-9410
Mailing Address - Fax:
Practice Address - Street 1:792 BEACON ST
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-1977
Practice Address - Country:US
Practice Address - Phone:617-655-9410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty