Healthcare Provider Details

I. General information

NPI: 1871343665
Provider Name (Legal Business Name): SOPHIA LYNN BERKENPAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-5214 KEANALEHU DR
KAILUA KONA HI
96740
US

IV. Provider business mailing address

2743 DUPONT AVE S APT 3
MINNEAPOLIS MN
55408-1277
US

V. Phone/Fax

Practice location:
  • Phone: 808-355-5650
  • Fax:
Mailing address:
  • Phone: 763-516-4718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: