Healthcare Provider Details

I. General information

NPI: 1568302008
Provider Name (Legal Business Name): BERKSHIRE PROSTHETIC AND RESTORATIVE DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WENDELL AVE APT 1
PITTSFIELD MA
01201-6975
US

IV. Provider business mailing address

114 WENDELL AVE APT 1
PITTSFIELD MA
01201-6975
US

V. Phone/Fax

Practice location:
  • Phone: 413-442-8684
  • Fax:
Mailing address:
  • Phone: 413-442-8684
  • Fax:

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: MICHELLE DICKINSON
Title or Position: ACCESS MANAGER
Credential:
Phone: 413-884-4383