Provider Demographics
NPI:1629082052
Name:RONALD M. GERECHT DDS & H. MICHAEL GOLDBERG DDS A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:RONALD M. GERECHT DDS & H. MICHAEL GOLDBERG DDS A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-953-5401
Mailing Address - Street 1:2031 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2958
Mailing Address - Country:US
Mailing Address - Phone:818-953-5401
Mailing Address - Fax:818-953-2811
Practice Address - Street 1:2031 W ALAMEDA AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2958
Practice Address - Country:US
Practice Address - Phone:818-953-5401
Practice Address - Fax:818-953-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty