Provider Demographics
NPI:1225483787
Name:DURAN, BERTHA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:BERTHA
Other - Middle Name:
Other - Last Name:ARREDONDO SALAZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4364 BONITA RD.
Mailing Address - Street 2:#233
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLVD. AGUA CALIENTE 4558
Practice Address - Street 2:CENTRO MEDICO 2 STE C2-8
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22400
Practice Address - Country:MX
Practice Address - Phone:01152664-681-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2266950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist