Provider Demographics
NPI:1154944767
Name:BERTHA ERIVES DDS
Entity type:Organization
Organization Name:BERTHA ERIVES DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERHA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:ERIVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-777-3087
Mailing Address - Street 1:745 S MESA HILLS DR STE E440
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5571
Mailing Address - Country:US
Mailing Address - Phone:915-777-3087
Mailing Address - Fax:
Practice Address - Street 1:PEDRO S. VARELA 3007
Practice Address - Street 2:16
Practice Address - City:CD JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32317
Practice Address - Country:MX
Practice Address - Phone:656-616-1509
Practice Address - Fax:656-613-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty