Provider Demographics
NPI:1285747337
Name:BERKOW, JERRY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALAN
Last Name:BERKOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 NORTHLAKE CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5838
Mailing Address - Country:US
Mailing Address - Phone:301-617-0577
Mailing Address - Fax:
Practice Address - Street 1:101 RIDGELY AVE STE 20
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1409
Practice Address - Country:US
Practice Address - Phone:410-263-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD75441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice