Provider Demographics
NPI:1992842066
Name:BERWALD, BARBRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARBRA
Middle Name:
Last Name:BERWALD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BARBRA
Other - Middle Name:
Other - Last Name:BERWALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:75 COW NECK RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1114
Mailing Address - Country:US
Mailing Address - Phone:516-883-1498
Mailing Address - Fax:212-425-2120
Practice Address - Street 1:1044 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1514
Practice Address - Country:US
Practice Address - Phone:516-672-1881
Practice Address - Fax:212-425-2120
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0476911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics