Provider Demographics
NPI:1568663821
Name:KEN BERLEY, D.D.S., LTD.
Entity Type:Organization
Organization Name:KEN BERLEY, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,OWNER,DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-254-0200
Mailing Address - Street 1:5417 PINNACLE POINT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8120
Mailing Address - Country:US
Mailing Address - Phone:479-254-0200
Mailing Address - Fax:479-254-0600
Practice Address - Street 1:5417 PINNACLE POINT
Practice Address - Street 2:SUITE 200
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8120
Practice Address - Country:US
Practice Address - Phone:479-254-0200
Practice Address - Fax:479-254-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58912OtherBLUE CROSS NUMBER
AR58912OtherBLUE CROSS NUMBER