Provider Demographics
NPI:1669937066
Name:H ROBERT VAN DEN BERG DDS INC
Entity type:Organization
Organization Name:H ROBERT VAN DEN BERG DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:VAN DEN BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-650-6560
Mailing Address - Street 1:1501 BOLLINGER CANYON RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1758
Mailing Address - Country:US
Mailing Address - Phone:925-838-0665
Mailing Address - Fax:
Practice Address - Street 1:230 S STERLING DR STE 233
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOUSE
Practice Address - State:CA
Practice Address - Zip Code:95391-3046
Practice Address - Country:US
Practice Address - Phone:209-650-6560
Practice Address - Fax:209-407-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-10
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty