Provider Demographics
NPI:1922142587
Name:BERSTIS, HARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:BERSTIS
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 1:85 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1417
Mailing Address - Country:US
Mailing Address - Phone:781-592-0222
Mailing Address - Fax:781-592-0750
Practice Address - Street 1:85 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1417
Practice Address - Country:US
Practice Address - Phone:781-592-0222
Practice Address - Fax:781-592-0750
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA98031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA009803OtherTUFTS
MA0299383Medicaid
MA16343OtherHPHC
MAM12059OtherBCBS