Provider Demographics
NPI:1225108335
Name:BERST DENTAL PC
Entity Type:Organization
Organization Name:BERST DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BERST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-247-7008
Mailing Address - Street 1:4900 N RIVER BLVD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:ID
Mailing Address - Zip Code:52411
Mailing Address - Country:US
Mailing Address - Phone:319-247-7008
Mailing Address - Fax:319-378-0937
Practice Address - Street 1:4900 N RIVER BLVD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:ID
Practice Address - Zip Code:52411
Practice Address - Country:US
Practice Address - Phone:319-247-7008
Practice Address - Fax:319-378-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty