Provider Demographics
NPI:1508911702
Name:BERK, NICOLE H (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:H
Last Name:BERK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2952
Mailing Address - Country:US
Mailing Address - Phone:856-227-2727
Mailing Address - Fax:856-227-6737
Practice Address - Street 1:61 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2952
Practice Address - Country:US
Practice Address - Phone:856-227-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD0216831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice