Provider Demographics
NPI:1215908116
Name:BERCHTOLD, THOMAS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BERCHTOLD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SAXONY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3791
Mailing Address - Country:US
Mailing Address - Phone:760-634-5437
Mailing Address - Fax:
Practice Address - Street 1:5915 S ZANG ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4608
Practice Address - Country:US
Practice Address - Phone:720-330-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5142466-99211223G0001X
CODEN.002043311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice