Provider Demographics
NPI:1306136023
Name:DENTAL CARE OF BERLIN, LLC
Entity type:Organization
Organization Name:DENTAL CARE OF BERLIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-691-2553
Mailing Address - Street 1:115 N ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-9202
Mailing Address - Country:US
Mailing Address - Phone:856-768-5151
Mailing Address - Fax:856-768-2966
Practice Address - Street 1:115 N ROUTE 73
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-9202
Practice Address - Country:US
Practice Address - Phone:856-768-5151
Practice Address - Fax:856-768-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty