Provider Demographics
NPI:1750882676
Name:BERSHADSKY DENTAL CORPORATION
Entity type:Organization
Organization Name:BERSHADSKY DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERSHADSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-883-7979
Mailing Address - Street 1:6543 TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2622
Mailing Address - Country:US
Mailing Address - Phone:818-883-7979
Mailing Address - Fax:818-883-4498
Practice Address - Street 1:6543 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91303-2622
Practice Address - Country:US
Practice Address - Phone:818-883-7979
Practice Address - Fax:818-883-4498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERSHADSKY DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255545976OtherNPI