Provider Demographics
NPI:1427077973
Name:CHERTOK, KEITH ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ROBERT
Last Name:CHERTOK
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 1:2620 ASHBY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2208
Mailing Address - Country:US
Mailing Address - Phone:510-548-0150
Mailing Address - Fax:510-548-0156
Practice Address - Street 1:2620 ASHBY AVE STE 101
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2208
Practice Address - Country:US
Practice Address - Phone:510-548-0150
Practice Address - Fax:510-548-0156
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics