Healthcare Provider Details

I. General information

NPI: 1144989203
Provider Name (Legal Business Name): JEFF BERLIN DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE 403
BEVERLY HILLS CA
90211-2004
US

IV. Provider business mailing address

8920 WILSHIRE BLVD STE 403
BEVERLY HILLS CA
90211-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-720-8250
  • Fax:
Mailing address:
  • Phone: 310-720-8250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: FAITH GASKINS
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 972-869-3789