Healthcare Provider Details

I. General information

NPI: 1922142587
Provider Name (Legal Business Name): HARRY BERSTIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 EXCHANGE ST
LYNN MA
01901-1417
US

IV. Provider business mailing address

85 EXCHANGE ST
LYNN MA
01901-1417
US

V. Phone/Fax

Practice location:
  • Phone: 781-592-0222
  • Fax: 781-592-0750
Mailing address:
  • Phone: 781-592-0222
  • Fax: 781-592-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9803
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: