Provider Demographics
NPI:1740435833
Name:ROUBINIAN, BERGE (DDS)
Entity type:Individual
Prefix:MR
First Name:BERGE
Middle Name:
Last Name:ROUBINIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 VAN NESS AVE.
Mailing Address - Street 2:#102
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2504
Mailing Address - Country:US
Mailing Address - Phone:415-771-2127
Mailing Address - Fax:415-771-0350
Practice Address - Street 1:2243 VAN NESS AVE
Practice Address - Street 2:#102
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-2504
Practice Address - Country:US
Practice Address - Phone:415-771-2127
Practice Address - Fax:415-771-0350
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist