Provider Demographics
NPI:1508879180
Name:RICHARD G BERUBE AND STEPHEN G BERUBE DMD PLLC
Entity Type:Organization
Organization Name:RICHARD G BERUBE AND STEPHEN G BERUBE DMD PLLC
Other - Org Name:GERBER DENTAL GROUP - PORTSMOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERUBE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-436-8822
Mailing Address - Street 1:1800 WOODBURY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-436-8822
Mailing Address - Fax:603-431-3948
Practice Address - Street 1:1800 WOODBURY AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-436-8822
Practice Address - Fax:603-431-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25831223G0001X
NH25901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty