Provider Demographics
NPI:1336675354
Name:BERLIN AND LEVITT DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:BERLIN AND LEVITT DENTAL PARTNERSHIP
Other - Org Name:TOOTH SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-721-8250
Mailing Address - Street 1:1050 S GRAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4284
Mailing Address - Country:US
Mailing Address - Phone:310-721-8250
Mailing Address - Fax:
Practice Address - Street 1:1050 S GRAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4284
Practice Address - Country:US
Practice Address - Phone:310-721-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55277122300000X
CA473501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty