Healthcare Provider Details

I. General information

NPI: 1215908116
Provider Name (Legal Business Name): THOMAS BERCHTOLD DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 S ZANG ST
LITTLETON CO
80127-4608
US

IV. Provider business mailing address

135 SAXONY RD STE 200
ENCINITAS CA
92024-3791
US

V. Phone/Fax

Practice location:
  • Phone: 720-330-2712
  • Fax:
Mailing address:
  • Phone: 760-634-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5142466-9921
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN.00204331
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: