Healthcare Provider Details

I. General information

NPI: 1679696645
Provider Name (Legal Business Name): NORTH BERKELEY DENTAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 VENTURA AVE
ALBANY CA
94707-2122
US

IV. Provider business mailing address

901 VENTURA AVE
ALBANY CA
94707-2122
US

V. Phone/Fax

Practice location:
  • Phone: 510-526-1757
  • Fax: 510-526-3397
Mailing address:
  • Phone: 510-526-1757
  • Fax: 510-526-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number50183
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number46869
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number20885
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number20885
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number50151
License Number StateCA

VIII. Authorized Official

Name: NORMA ICARANGAL
Title or Position: ACCOUNTING EXECUTIVE
Credential:
Phone: 510-526-6574