Provider Demographics
NPI:1679670699
Name:BERTSCH, JOHN E (DDA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:BERTSCH
Suffix:
Gender:M
Credentials:DDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 FRANCISCO DR STE 460
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3780
Mailing Address - Country:US
Mailing Address - Phone:916-933-3011
Mailing Address - Fax:916-933-6011
Practice Address - Street 1:2222 FRANCISCO DR STE 460
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-3780
Practice Address - Country:US
Practice Address - Phone:916-933-3011
Practice Address - Fax:916-933-6011
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice