Provider Demographics
NPI:1578644787
Name:BERKINSHAW ORTHODONTICS PA
Entity Type:Organization
Organization Name:BERKINSHAW ORTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERKINSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:410-266-8880
Mailing Address - Street 1:129 OLD SOLOMONS ISLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-266-8880
Mailing Address - Fax:410-224-3297
Practice Address - Street 1:129 OLD SOLOMONS ISLAND ROAD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-8880
Practice Address - Fax:410-224-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD76581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty