Healthcare Provider Details

I. General information

NPI: 1427077973
Provider Name (Legal Business Name): KEITH ROBERT CHERTOK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 ASHBY AVE STE 101
BERKELEY CA
94705-2208
US

IV. Provider business mailing address

2620 ASHBY AVE STE 101
BERKELEY CA
94705-2208
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-0150
  • Fax: 510-548-0156
Mailing address:
  • Phone: 510-548-0150
  • Fax: 510-548-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number38634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: