Healthcare Provider Details

I. General information

NPI: 1841963931
Provider Name (Legal Business Name): BERKAY T SUER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 05/04/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 MIDDLE TPKE W
MANCHESTER CT
06040-3863
US

IV. Provider business mailing address

483 MIDDLE TPKE W
MANCHESTER CT
06040-3863
US

V. Phone/Fax

Practice location:
  • Phone: 860-645-0111
  • Fax:
Mailing address:
  • Phone: 860-645-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number115078-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN25993
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02870600
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13179
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: