Healthcare Provider Details

I. General information

NPI: 1629082052
Provider Name (Legal Business Name): RONALD M. GERECHT DDS & H. MICHAEL GOLDBERG DDS A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 W ALAMEDA AVE SUITE 320
BURBANK CA
91506-2958
US

IV. Provider business mailing address

2031 W ALAMEDA AVE SUITE 320
BURBANK CA
91506-2958
US

V. Phone/Fax

Practice location:
  • Phone: 818-953-5401
  • Fax: 818-953-2811
Mailing address:
  • Phone: 818-953-5401
  • Fax: 818-953-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HERBERT MICHAEL GOLDBERG
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 818-953-5401