Provider Demographics
NPI:1801533526
Name:BERHOLD, ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:BERHOLD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 W BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4806
Mailing Address - Country:US
Mailing Address - Phone:813-849-0002
Mailing Address - Fax:
Practice Address - Street 1:10901 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:CARROLLWOOD
Practice Address - State:FL
Practice Address - Zip Code:33618-4112
Practice Address - Country:US
Practice Address - Phone:813-849-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-14
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38393122300000X
FL26797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist