Provider Demographics
NPI:1326878950
Name:WALL PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:WALL PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-598-1782
Mailing Address - Street 1:2107 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9104
Mailing Address - Country:US
Mailing Address - Phone:732-963-2130
Mailing Address - Fax:732-963-2134
Practice Address - Street 1:2107 ROUTE 34
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9104
Practice Address - Country:US
Practice Address - Phone:732-963-2130
Practice Address - Fax:732-963-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty