Provider Demographics
NPI:1992835425
Name:MIKHAIL BERDICHEVSKY, D.D.S., INC.
Entity Type:Organization
Organization Name:MIKHAIL BERDICHEVSKY, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDICHEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-386-5590
Mailing Address - Street 1:4444 GEARY BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3048
Mailing Address - Country:US
Mailing Address - Phone:415-386-5590
Mailing Address - Fax:415-386-5592
Practice Address - Street 1:4444 GEARY BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3048
Practice Address - Country:US
Practice Address - Phone:415-386-5590
Practice Address - Fax:415-386-5592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41158261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental