Provider Demographics
NPI:1982870838
Name:BERKSHIRE DENTAL GROUP PLC
Entity Type:Organization
Organization Name:BERKSHIRE DENTAL GROUP PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:918-250-9528
Mailing Address - Street 1:8701 S GARNETT RD
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:918-250-9528
Mailing Address - Fax:918-250-9529
Practice Address - Street 1:8701 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:918-250-9528
Practice Address - Fax:918-250-9529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERKSHIRE DENTAL GROUP PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46601223G0001X
OK43011223G0001X
OK41561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty