Provider Demographics
NPI:1396800678
Name:BERKSHIRE DENTAL ASSOCIATES, LTD.
Entity type:Organization
Organization Name:BERKSHIRE DENTAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SHUTTLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-376-3210
Mailing Address - Street 1:1260 BROADCASTING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3223
Mailing Address - Country:US
Mailing Address - Phone:610-376-3210
Mailing Address - Fax:610-376-2140
Practice Address - Street 1:1260 BROADCASTING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3223
Practice Address - Country:US
Practice Address - Phone:610-376-3210
Practice Address - Fax:610-376-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025949L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty