Provider Demographics
NPI:1194000521
Name:STEVEN A. BERKLACY, D.D.S., INC.
Entity Type:Organization
Organization Name:STEVEN A. BERKLACY, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BERKLACY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-743-0700
Mailing Address - Street 1:6144 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1062
Mailing Address - Country:US
Mailing Address - Phone:918-743-0700
Mailing Address - Fax:918-744-8282
Practice Address - Street 1:6144 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1062
Practice Address - Country:US
Practice Address - Phone:918-743-0700
Practice Address - Fax:918-744-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty