Provider Demographics
NPI:1417053638
Name:JOHN BERWIND DDS PS
Entity type:Organization
Organization Name:JOHN BERWIND DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERWIND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PS
Authorized Official - Phone:360-423-4020
Mailing Address - Street 1:911 11TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2547
Mailing Address - Country:US
Mailing Address - Phone:360-423-4020
Mailing Address - Fax:360-636-1460
Practice Address - Street 1:911 11TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2547
Practice Address - Country:US
Practice Address - Phone:360-423-4020
Practice Address - Fax:360-636-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty