Provider Demographics
NPI:1508289489
Name:BERKE DENTAL CORPORATION
Entity Type:Organization
Organization Name:BERKE DENTAL CORPORATION
Other - Org Name:GOLDEN AGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-992-2999
Mailing Address - Street 1:701 S RAYMOND AVE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-5201
Mailing Address - Country:US
Mailing Address - Phone:714-992-2999
Mailing Address - Fax:714-992-0759
Practice Address - Street 1:701 S RAYMOND AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-5201
Practice Address - Country:US
Practice Address - Phone:714-992-2999
Practice Address - Fax:714-992-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty