Provider Demographics
NPI:1790792455
Name:BERCUTT, ROBERT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:BERCUTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3756 SANTA ROSALIA DR
Mailing Address - Street 2:SUITE #310
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3615
Mailing Address - Country:US
Mailing Address - Phone:323-292-0369
Mailing Address - Fax:323-292-7396
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:SUITE #310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3615
Practice Address - Country:US
Practice Address - Phone:323-292-0369
Practice Address - Fax:323-292-7396
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA17433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist