Provider Demographics
NPI:1760740518
Name:BERTO, ANTONIO (DDS)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:BERTO
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 1:2820 MCKINNON ST APT 3057
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1019
Mailing Address - Country:US
Mailing Address - Phone:214-457-9281
Mailing Address - Fax:
Practice Address - Street 1:7200 N HIGHWAY 161 STE 215
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3833
Practice Address - Country:US
Practice Address - Phone:972-556-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics