Provider Demographics
NPI:1790126621
Name:KENNETH M. BERRIN, DDS, INC.
Entity Type:Organization
Organization Name:KENNETH M. BERRIN, DDS, INC.
Other - Org Name:COMMUNITY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-486-2224
Mailing Address - Street 1:13132B POWAY RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4612
Mailing Address - Country:US
Mailing Address - Phone:858-486-2224
Mailing Address - Fax:858-486-2317
Practice Address - Street 1:13132B POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4612
Practice Address - Country:US
Practice Address - Phone:858-486-2224
Practice Address - Fax:858-486-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29775332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255338190OtherNPI NUMBER
CA29775OtherSTATE LICENSE